Rheumatoid arthritis (RA) causes inflammation when your body’s immune system attacks your tissues instead of foreign invaders like viruses and bacteria. Because RA is a systemic disease, its swelling and irritation can target multiple parts of your body. Most peopleassociate this autoimmune disease with joint pain, but it also may affect your eyes.
“The eye is like a microcosm of the entire body within a small little ball,” said Sunir J. Garg, M.D., attending retina surgeon at Wills Eye Hospital in Philadelphia, Pa. RA inflammation affects collagen, the main component of connective tissue including your eyes. Vulnerable areas include your tear ducts as well as the outside and inside parts of your eyes.
A study of 691 RA patients found that 27 percent had inflammatory eye conditions. Learn how to recognize common eye symptoms including dryness, redness, pain, light sensitivity and blurry vision associated with RA so you can get proper medical treatment.
Identifying Keratoconjunctivitis Sicca
Proper tear production lubricates your eyes, protects them from foreign particles and is necessary for good vision. When RA inflammation occurs in your tear ducts, they’re unable to maintain healthy films of tears. Keratoconjunctivitis sicca(keratitis sicca or dry eye syndrome) includes dryness of the conjunctiva (the membrane that lines your eyelids and covers the whites of your eyes) and the cornea (the clear lens cap over your colored iris and dark pupil).
“Dry eye syndrome is the most common ophthalmic manifestation of rheumatoid arthritis,” said Cleveland Clinic ophthalmologist Careen Lowder, M.D., PhD. It affects women nine times more often than men. About four in 10 RA patients experiencing grittiness, burning, sticky mucus, redness and/or blurry vision. You also may have the feeling that some foreign object is in your eye.
Symptoms may worsen with eyestrain, during cold dry air exposure and in the evening. “When the corneal lens starts to dry out, it’s not an effective barrier,” said Dr. Garg. Dry eyes may lead to infection and corneal scarring, which resembles straining to see through a dirty windshield.
Both optometrists and ophthalmologists can diagnose and treat dry eye syndrome. A Schirmer’s test can measure the amount of moisture in your eyes. Treatments include moisturizing drops and ointments. Restasis prescription eye drops block eye inflammation while improving tear production. Wearing protective sunglasses on dry, windy days also may help.
RA inflammation can cause your eye wall, or sclera, to thin. “That’s bad because minor trauma could cause that part of the eyeball to split open,” Dr. Garg said. Scleritis affects about one in 10 RA patients. Symptoms include redness and deep eye pain that can radiate to your face and scalp, possibly causing a headache. Scleritis also may involve light sensitivity, tearing and reduced vision. Your symptoms may be worse at night. Episcleritis is a less severe and superficial inflammation of the membrane that covers the white part of your eye or sclera.
An ophthalmologist usually can diagnose these conditions during an eye exam. In some cases, corticosteroid eye drops may control inflammation. But more often, the problem is too deep within the eye for local treatments to be effective. Depending on the severity of your eye inflammation, your doctor may prescribe an oral non-steroidal anti-inflammatory drug (NSAID), glucocorticoid or immunosuppressive drug.
Scleritis usually is an indication that inflammation is out of control elsewhere in your body — not just in your eyes. Scleromalacia perforans, a rare scleritis complication, creates severe eye inflammation that may cause permanent damage. These serious concerns reinforce the importance of managing your RA with medication and attending to any side effects immediately.
Detecting Peripheral Ulcerative Keratitis
This inflammatory condition affects your peripheral cornea, the clear membrane that covers your iris and pupil. Inflammatory cell deposits collect on the edge of your cornea, or ulcers form there. Keratitis can melt and even perforate your relatively thin cornea. Symptoms include redness and eye pain that can be severe with possible blurring and even loss of vision.
Peripheral ulcerative keratitis (PUK) develops with active scleritis often, or you may have it alone. Unfortunately, local treatments aren’t effective. Medication choice depends on the severity of your eye inflammation. Like scleritis, options include oral non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and immunosuppressive drugs.
If you have uveitis, inflammation occurs in the inner part of your eye between your retina and the white of your eye. It can affect your iris and choroid (inside lining). Symptoms include blurred vision, dark spots in your vision, redness, pain and light sensitivity. Seeking prompt medical attention is vital. If this serious condition persists longer than three months without treatment, it can cause blindness.
An ophthalmologist may use a special slit lamp tool to diagnose uveitis. Treatments include steroid eye drops and pills. Drops can open your eyes’ lenses, which will reduce pain and prevent scarring. Also wear dark glasses to help protect your eyes.
Caring for Your Eyes
Regular eye checkups at least once a year are vital because your eyes are especially vulnerable to RA inflammation. If you develop keratoconjunctivitis sicca, scleritis, keratitis or uveitis symptoms between annual appointments, see an ophthalmologist for timely diagnosis and treatment to prevent permanent damage. In addition to taking an RA prescription like Azathioprine, you also may need to add eye drops, an ointment, NSAID, oral steroid or other medication.