How Rheumatoid Arthritis Can Affect the Eyes

Rheumatoid arthritis is an autoimmune condition affecting over 1.3 Americans that can cause joint pain and damage throughout the body. RA affects more women than men. Patients often complain of joint stiffness, fever, weight loss, and malaise, and have inflammatory polyarthritis. Because RA is an autoimmune condition, it can affect all the systems of the body, including the ocular system. Furthermore, some of the medications used to treat RA, can cause eye conditions. For example, Plaquenil can rarely cause retinopathy, and prednisone can cause or worsen cataracts or glaucoma. The following is a brief examination of a few of the conditions that can result from RA or its treatment. RA and Dry Eye Disease The most common eye disorder affecting patients with RA is dry eye syndrome, which is also known as keratoconjunctivitis sicca. It may result from dysfunction in various of the glands in the eye or goblet cell dysfunction. With dry eye, patients feel like they have something in their eye. Their eyes may burn, be sensitive to light, and in fact patients’ vision can be impacted. Up to 25% of patients with RA have an associated condition called Sjogren syndrome. Like with other autoimmune disease, the immune system attacks its own body, in this case the glands that make tears and saliva. In addition to dry eyes and dry mouth, Sjogren’s can come with fatigue and joint and muscle pain. Dry eye can be problematic in addition to causing discomfort because it makes injury and infection more likely in the absence of tears to protect the eye. RA dry eye is generally treated with eyedrops and ointments, topical steroids, and oral pilocarpine. In 2016, the FDA approved a new drug for the treatment of dry eye disease. Read further about how amniotic eye transplants can help with severe chronic dry eye. RA and episcleritis RA can also lead to episcleritis, which is an inflammation of the clear layer on top of the sclera (the white of the eye). It affects both eyes 40% of the time, causing pink eyes and pain. Doctors will prescribe topical corticosteroids or NSAIDs for the symptoms. There are two slightly different forms of episcleritis, simple, which ap pears as redness without much discomfort, and nodular, where the redness is more localized and there are raised bumps surrounded by dilated blood vessels. This latter form might be uncomfortable. Both forms can cause tearing, photosensitivity, and a hot, gritty sensation in the eye. The vision is not usually impacted, and the condition may resolve on its own, or resolve and return. RA and Scleritis Scleritis is inflammation of the sclera, the white part of the eye. RA is the most common cause of scleritis and may be a symptom that indicates to patients that they have RA because scleritis often begin before other symptoms of RA. In 40-50% of the time, it occurs in both eyes. There are a few kinds of scleritis: – Anterior: causes intense pain especially with eye movements, blurry vision, light sensitivity, and tearing. – Scleromalacia perforans: appears without inflammation. This condition is usually not painful but can lead to vision loss including astigmatism, and globe perforation. – Posterior scleritis: can cause serious retinal detachment or chorioretinal folds. Topical medications for scleritis generally won’t work, and doctor and patient must manage the RA. Scleritis can cause serious vision impairment and is associated with increased mortality of RA patients.
PUK, one of the disorders of the eye that might be caused by RA.
RA and PUK Peripheral ulcerative keratitis (PUK) is caused by immune complexes entering the vascular arcades of the corneal periphery. 34% of cases of this corneal melt are caused by RA. It can appear with necrotizing scleritis. It causes stromal thinning and epithelial defect with crescent-shaped ulcers. It usually occurs in only one eye, and may cause pain, light sensitivity, tearing, and vision problems. RA and Glaucoma Inflammatory form of arthritis can increase the pressure of the fluid in the eye, which leads to damage in the optic nerves. Early on, glaucoma may have no symptoms although it threatens the patient’s vision, so regular ophthalmological care is important. RA and Cataracts While in the general population, cataracts are seen largely in older individuals, RA can cause cataracts at any age. RA and Uveitis The uvea is between the sclera and the retina (in the back of the eye). With uveitis, the uvea becomes inflamed. Patients might notice blurred vision, floaters, pain, redness and photosensitivity. If untreated, it can lead to vision loss. Uveitis is another condition that can go without symptoms, making it essential that you have your eyes examined regularly if you have RA. Other Ocular Problems with RA Rarely, RA can cause retinal vasculitis, inflammation of the vascular branches of the retinal artery. It can lead to blindness. It is diagnosed with a fundus fluorescein angiograph. Treatments vary depending on the condition and the severity, and includes alpha interferon, monoclonal antibodies, and anti-platelet medication. Conclusion It is important to report any ocular changes to your doctor when you have RA, and continue to be aggressive in managing your RA. Contact your doctor if you suspect you may have RA, as treatments are most effective when they occur early.