The Importance Of Regular Eye Care With Arthritis
Its critical for anyone with inflammatory arthritis to get regular preventive eye care and to let your rheumatologist or eye doctor know if youre having new or unusual eye-related symptoms, no matter how minor they may seem. Annual dilated eye exams at the eye doctor are important to check for underlying damage early on. Some eye diseases might not cause a lot of pain or much change in vision, especially in earlier stages, so an eye exam is always necessary, Dr. Akpek says.
Dr. Wu requires annual exams from her inflammatory arthritis patients if there are no issues and wants to see patients more frequently if there are any problems.
All of the physicians we interviewed stressed the importance of fostering communication between rheumatologists and ophthalmologists. As a patient, you can help make sure your health care providers are sharing medical records and are up to date on any new symptoms, diagnoses, or treatment changes. Dont ever assume one doctor knows what the other does.
What Happens During An Ophthalmologist Appointment
The eye exam performed by the ophthalmologist is painless and lasts several minutes. Be sure to tell the ophthalmologist about the medicines your child is taking.
Prior to the eye exam, the ophthalmologist will put drops in your child’s eyes to make the pupils bigger . Dilating your child’s eyes helps the doctor clearly view the inside of the eyes.
To detect eye inflammation, the ophthalmologist uses a special microscope called a slit lamp. The machine shines a thin beam of light into one eye at a time so the doctor can view the inside of the eyes.
A visual field exam might also be performed to detect vision changes.
Ocular Manifestations Of Autoimmune Disease
SAYJAL J. PATEL, LT, MC, USNR, and DIANE C. LUNDY, CAPT, MC, USN
Naval Medical Center, San Diego, California
Am Fam Physician.;2002;Sep;15;66:991-998.
Patients with autoimmune diseases are frequently encountered by family physicians. It is important to understand not only the systemic effects of these diseases but also their ocular manifestations . Most ocular complications involve the cornea but may also include the conjunctiva, uvea, sclera, retina, and surrounding structures . The majority of these diseases will ultimately need to be referred to an ophthalmologist.
Ocular Manifestations of Autoimmune Disease
Rheumatoid arthritis
Ocular Manifestations of Autoimmune Disease
Rheumatoid arthritis
Cross section of the eye.
FIGURE 1.
Cross section of the eye.
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What Is Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune and inflammatory disease. This means that your immune system will attack healthy cells in your body by mistake and cause painful inflammation. Rheumatoid arthritis mainly affects the tissue of your joints, but can also cause medical problems with your heart, lungs, nerves, eyes, and skin.
Treating Dry Eye Syndrome
In good news, dry eye syndrome is relatively easy to treat with moisturizing eye drops and eye ointments at night, says Dr. Feinberg. Mainly we use over-the-counter drops; they dont have to be prescription. He recommends choosing a brand thats free from preservatives to avoid irritating the eye further. If over-the-counter fixes arent doing the job, there are prescription medications that stimulate the glands to produce moisture, such as Salagen or Evoxac .
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What Are Symptoms Of Uveitis
Uveitis can affect one or both eyes, and symptoms often develop rapidly. However, in some patients, the symptoms can occur more gradually. Several other autoimmune disorders, such as rheumatoid arthritis and lupus, are also known to cause an increased risk for developing uveitis.2,4
Symptoms of uveitis include:
- Redness of the eye
- Sensitivity to light 3,4
Uveitis can cause permanent vision damage, even with treatment. Additional complications may include cataracts, fluid within the retina, glaucoma, retinal detachment, and vision loss or blindness. Early treatment is important to reduce the risk of complications, and patients with eye pain, severe light sensitivity, or any change in vision should immediately see an ophthalmologist for examination. 3,4
Eye Concern #: Cataracts And Nerve Damage From Steroids
Steroids are highly effective at treating inflammation, but using them can increase your risk of developing cataracts, a clouding of the lens of the eye, says Dr. Feinberg. Another effect of long-term steroid use is steroid-induced glaucoma. Steroids can cause changes in the eyes drainage system that result in eye pressure and, if left untreated, lead to optic nerve damage.
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How Psoriatic Arthritis Affects Your Eyes
Both psoriasis and psoriatic arthritis are autoimmune diseases. That means they cause your body to attack itself by mistake. This can trigger inflammation in certain parts of the body, including your eyes.
If your eyes are irritated and you have psoriasis, you may have uveitis. That’s a term for any inflammation inside your eye. It can lead to swelling and damaged eye tissue. Uveitis may affect one or both eyes. Symptoms include:
Your eye doctor can treat pinkeye.
Glaucoma. This is a group of conditions that damage your optic nerve. It often starts with inflammation that causes a buildup of pressure in your eye. Symptoms include:
You may not have any of these if the disease is in its early stages. That’s why regular eye exams are important. Your eye doctor can catch it even if yoâre not showing symptoms. Glaucoma can also be a side effect of taking corticosteroids for psoriatic arthritis. Talk to you doctor about how to lower this risk.
Cataracts. That âs when inflammation turns the clear lens of your eye cloudy. Symptoms can include:
- Trouble seeing at night
Uveitis Scleritis And Dry Eye Syndrome
While arthritis is primarily a joint disease, several types of arthritis can have systemic effectsincluding some eye problems.
Systemic inflammatory conditions that have possible eye-related symptoms include:
In this article, you’ll learn about three common eye conditions associated with systemic inflammatory disease.
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Reducing The Risk Of Uveitis
Early and aggressive treatment of PsA reduces the risk of long-term complications, such as uveitis. In addition, treatment for PsA can slow or prevent potential joint damage, deformity, and loss of function. Early treatment of uveitis is also critical to eliminate inflammation, alleviate pain, prevent further tissue damage, and potentially restore any loss of vision. While systemic treatments for PsA that reduce inflammation will help in reducing the inflammation of uveitis, specific treatment for the eyes is usually required. Treatment for uveitis includes steroidal anti-inflammatory medication that may be taken as eye drops, pills, injections around or into the eye, intravenous administration or a capsule that is surgically implanted inside the eye.2,3,5
Visiting An Eye Care Specialist
People with RA who experience any change in vision should be evaluated right away. Even if you do not have symptoms of eye problems, regular eye exams may be recommended to monitor for changes in your vision.
There are several different types of eye care professionals. The training and expertise of each type of professional is different, so it is important that you see the right doctor for your needs:7,8
- Ophthalmologist These are doctors who are licensed to practice medicine and surgery. An ophthalmologist can diagnose and treat all eye diseases, perform eye surgery, and prescribe/fit corrective lenses. Many ophthalmologists often conduct research on the causes and cures for eye disease and disorders. Some ophthalmologists also specialize in specific areas of eye care, allowing them to treat more complex or specific conditions of the eye. In many cases, people with RA are referred to an ophthalmologist to manage eye problems.
- Optometrist An optometrist provides primary vision care. This involves performing eye exams, diagnosing certain eye abnormalities, prescribing drugs for eye disease, and prescribing/fitting corrective lenses. An optometrist is not a medical doctor, but has received a doctor of optometry degree from a 4-year optometry school.
Some people with RA may be referred to a neuro-ophthalmologist.
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When To See An Ophthalmologist
Anyone with PsA should consider undergoing annual eye examinations and regular doctor visits to discuss any new or existing eye-related symptoms.
Some eye conditions do not have any signs in the beginning stages. Due to this, it is vital to get regular eye checkups to detect any problems as soon as possible.
Ra And Your Eyes: What You Need To Know
Rheumatoid arthritis is known for joint pain, but it can also affect other parts of the body, including your eyes. Learn which rheumatoid arthritis symptoms and eye issues are most common, and how to manage them.
Most people think of rheumatoid arthritis;as a joint disease, but like other autoimmune disorders, it can impact different areas of the body as well. One of the more common complications for people with rheumatoid arthritis is eye problems, which can lead to corneal damage and ultimately impact vision if left untreated.
Some common eye conditions, like the ones described below, may affect people with rheumatoid arthritis . But there are steps to take to safeguard eye health and avoid permanent damage.
Dry Eyes
RA can be associated with extra-articular manifestations, and dry eyes are one of the most common problems, says Ana-Maria Orbai, MD, instructor of medicine in the division of rheumatology at the Johns Hopkins University School of Medicine in Baltimore. A person with dry eyes might experience itching, a sand-like sensation in the eyes, and redness.;They may also notice a lack of moisture or tears in the eyes, as well as blurred vision.
If you decide to go the over-the-counter route, avoid eye-drop products that have preservatives or vasoconstrictive agents, such as some from Visine and Clear Eyes, which often promise to relieve redness or take the red out, Orbai explains.
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Eye Concern #: Sjogren’s Syndrome Dry Eye
File under More Proof That Life Isnt Fair: About 25% of people who have one autoimmune disease go on to develop others. Sjogrens syndromean autoimmune condition that damages moisture-producing glands and causes dry eye as well as dry mouth, throat, and upper airwaysis particularly common in RA patients. In one study, more than 22% of people with RA had secondary Sjogrens . Fortunately, secondary Sjogrens is often a milder form than primary, but definitely dont ignore it or you risk permanent eyesight damage.
The Importance Of Uveitis Treatment
Waiting too long to have your eyes checked after symptoms start can delay treatment and allow damage to occur, so definitely dont drag your feet, says Dr. Ingraham.
Treatment for moderate inflammation from uveitis often involves steroid eye drops. For some people with more severe symptoms, the medication used to treat psoriasis or psoriatic arthritis may be used to treat or prevent uveitis. Your eye doctor and rheumatologist can work together to find your best course of treatment. Just as a conductor of a symphony coordinates multiple musicians, rheumatologists and ophthalmologists should achieve a similar collaboration, says Dr. Rosenbaum.
What about lifestyle factors; can they prevent eye problems related to psoriatic arthritis? Boy, I wish, says Dr. Rosenbaum. If you have a way to reduce stress, to be happy, to get sleep, to eat a balanced diet, do all of those things, but dont ignore conventional medications, which we know work well.
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Eye Concern #: A Red Painful Eye From Scleritis
Another type of eye inflammation, scleritis is more concerning than episcleritis because the inflammation is more severe and involves the sclera, the next layer down in the white of the eye. People with RA, as well as other inflammatory or autoimmune diseases, are at increased risk for scleritis. Symptoms include redness and pain, and it can lead to blindness, says Dr. Bhatt. The eye may also have a bluish tinge in the later stage. Patients with scleritis usually make a doc appointment right away because the pain, while not severe or stabbing, is difficult to tolerate.
Eye Concern #: Retinal Vasculitis
Retinal vasculitis occurs when swollen, inflamed blood vessels damage the back surface of the eye where light hits and nerve endings read what youre seeing, explains Dr. Feinberg. You usually dont know anything is wrong until you experience vision loss. Mild areas of vision loss or even complete blindness can happen suddenly, at which point its often too late to undo the damage, says Dr. Feinberg.
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How Uveitis Is Treated
Your doctor may give you steroid drops to reduce inflammation. Or, if your case is severe, you may need oral steroids or steroid shots around the eye the way we would inject a painful shoulder, Rosenbaum says. If an infection is the cause of the inflammation, you may be given an antibiotic as well, the;Arthritis Foundation;says.
Most of the time, drops work well if the uveitis affects the iris and the ciliary body. But if it affects the back of the eye, the drops have less ability to penetrate, and treatment becomes more complicated, Rosenbaum says.
In some people, says Rosenbaum, uveitis is short-lived and responds well to drops. But because its an episodic disease, people may go through a dormant period only to have it flare again. In other patients, its more chronic, and in a few , it will last years and years, he says.
Its somewhat like arthritis in that its unpredictable how it will twist and turn.
The hope is that, after taking steroid drops and tapering off them, your uveitis will go away, Conway says. Steroids aren’t a long-term solution because they can cause glaucoma, a rise in fluid pressure in your eye, and a steroid-induced cataract. Nonsteroidal drops are an alternative in some cases, Conway says.
If uveitis comes back, your doctor may put you on a systemic drug such as a methotrexate or a biologic to modulate your immune system, she adds. Methotrexate and biologics are drugs that also can treat your;psoriatic arthritis symptoms.
Does Rheumatoid Arthritis Impact Your Vision
Rheumatoid arthritis is an autoimmune condition which usually affects your hands, wrists and feet, causing pain and swelling. With RA, your immune system attacks your joint tissues mistakenly and can also attack your skin and blood vessels. The inflammatory response of the misfiring immune system can cause a variety of other symptoms. Although arthritis is mostly associated with joint problems, RA also commonly impacts your eyes, leading to loss of vision if left untreated over a long period. Often, its not RA itself but rather the medications used to treat RA that causes eye issues. A popular RA treatment, Plaquenil, has been known to trigger retinopathy, while another, prednisone, has been found to lead to cataracts and glaucoma in some cases.
Symptoms of RA typically are:
- Fatigue and weakness
These will usually be accompanied by eye issues such as:
- Dry eyes
- Retinal vascular occlusion
Were going to delve into the impacts of RA and discuss the symptoms you need to watch out for to know when to seek treatment. As with most eye diseases, the sooner you identify the issue and treat it, the better the chances are of preserving your vision.
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Hydroxychloroquine And Risk Of Vision Problems
Hydroxychloroquine is an antimalarial drug that is approved to treat RA. It reduces symptoms such as pain, swelling, and joint tenderness. Hydroxychloroquine improves physical function and reduces the frequency of RA flares.3
Vision problems are a possible side effect of hydroxychloroquine if it is used for a long time or at high doses. One study found that 7.5 percent of people who used this drug for at least 5 years had retina damage. In people who took lower doses, 2 percent had retina damage in the first 10 years of use. After 20 years of use, nearly 20 percent had retina damage. These results are higher than what has been seen in other studies. Nevertheless, studies generally have shown that the risk increases with duration and dose.4
A vision test is recommended when starting hydroxychloroquine and while taking this drug. The test may evaluate:3,4
- How sharp your vision is
- The scope or total area that you can see objects
- Your ability to tell different colors apart
- Any signs of damage to your retina or other eye structures
The American Academy of Ophthalmology recommends that you begin having annual eye exams after 5 years of taking hydroxychloroquine. You may need more frequent eye exams if:3,4
- You are on a high dose of hydroxychloroquine
- You have kidney or liver disease
- You are over the age of 65
- You have certain vision problems
Eye Concern #: Vision Issues And Floaters From Uveitis
Below the episclera and sclera layers of the eye is another layer called the uvea, and when inflammation occurs here its known as uveitis. There are two types: Anterior uveitis, at the front of the eye, and posterior uveitis, which is at the back of the eye and very rare. Patients with uveitis start having vision problems and seeing floaters around the eye, says Dr. Bhatt. They may also experience redness and pain. Symptoms can have a quick onset and also worsen rapidly.
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Is Your Arthritis Causing Eye Problems
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Arthritis is an autoimmune disease that causes inflammation, and most people think about it in terms of the joint pain that is commonly associated with the condition. However, there are many other ways that arthritis can affect your physiological functions, including those related to the eyes.
This is especially true when it comes to rheumatoid arthritis, which is one of the most common forms. While it is important for everyone to undergo regular eye health exams to increase the chances of catching eye conditions early, patients with arthritis need to be as proactive as possible in order to protect their eyesight.