Know the Signs of Eye Trouble and What to Do About It
Arthritis is a broad category of inflammatory diseases, and rheumatoid arthritis (RA) in particular is a systemic inflammatory disease — the symptoms can reach every area of your body. So, while RA is well known for attacking joints with pain, swelling and stiffness, it can just as easily bring that inflammation and discomfort to other organs and tissues.
Not every RA sufferer will experience eye changes, but it’s important to know which eye problems might pop up, and how to recognize them so you can protect your eye health and keep your vision sharp.
Why Your Eyes Are in Danger
RA sparks an autoimmune response that attacks certain components in your body, including the collagen in your connective tissue. There’s a good deal of connective tissue in your joints, and when this becomes inflamed, you experience the hallmark swelling, pain and stiffness in the knees, hips, hands and feet.
Your eyeballs also contain collagen; the highest concentration is in the sclera (the white of your eye) and the cornea (the lens). It follows that RA sufferers are particularly vulnerable to conditions that affect these two parts of the eyeball, although a variety of eye complications can occur.
Most Common Eye Problems With RA
The inflammation of RA can do a lot of damage to your eyes, but so can a lack of tear production, and even the medication you use to treat your condition. Therefore, there are some uncomfortable eye problems you should watch out for and never ignore.
Dry Eye Syndrome
Probably the most common eye problem that affects RA sufferers, dry eyes can be a mild irritation or a precursor to a serious problem. A lack of lubricating tears can make it feel like you have dirt in your eye, or a mild burning, and you may be more sensitive to light. Once the cornea begins to dry out, your vision may become blurry.
A healthy coating of natural tears not only keeps your eye moist and comfortable, it also protects against infection. Since medications are sometimes to blame for dry eyes, it may be worth looking into switching to another drug.
If your doctor detects Sjögren’s syndrome — an inflammatory disease that can occur alongside RA — good anti-inflammatory management and hydrating eye drops can help bring the symptoms under control.
RA can cause the whites of your eyes to thin, which sets the stage for serious trauma if you were to get a scratch or any foreign object lodged in your eye. The most obvious symptom of scleritis is redness over the white part that won’t go away, but it often brings severe pain and vision problems, too.
If you contract scleritis, you’ll need to take immediate steps to bring the inflammation down. Corticosteroid eye drops can help on the surface, but the condition likely runs deeper; keeping your RA under control with your systemic medication is vital for clearing up inflammation in the sclera.
Very dry eyes can leave them vulnerable to infection on the surface, a condition called conjunctivitis (commonly known as pink eye). When the cornea becomes infected and inflamed, your eyes could feel itchy and irritated, and your vision will suffer.
Sometimes the infection is more severe and penetrating. Although not as common as conjunctivitis, RA increases your risk of developing corneal melt, which is when your cornea develops a perforation, leading to a distortion in your iris and pupil and an open wound. This demands quick and careful treatment to keep your cornea and iris intact, and preserve your vision.
Most Common Eye Problems With RA
The uvea is the layer of blood vessels that sits between the retina and the sclera, and when RA inflames this part of the eye, you will notice pain and redness, along with blurry vision and sensitivity to light. Unlike other eye issues, serious, chronic uveitis tends to affect those with juvenile RA more often.
Left untreated, uveitis can cause scarring, and lead to permanent vision loss. Treatment typically begins with a corticosteroid eye drop, and if that doesn’t clear up the problem, your doctor may need to inject a corticosteroid directly into your eye.
Retinal Vascular Occlusion
This condition involves a blockage or interference in the blood vessels that feed the eyes, cutting off blood flow to the light-sensing part of your eye. Vision changes are more common than pain when retinal vascular occlusion is the problem: gradual darkening of your vision, or momentary blindness that comes and goes can signal a blockage in an artery.
The degree of permanent damage depends largely on what type of blood vessels has been blocked. If an artery is affected, your vision loss is more likely to be permanent; if the blockage occurs in a vein, laser surgery has been shown to help reverse the damage to your vision.
When RA affects the optic nerve, pressure can build up inside the eye, and that is bound to affect your vision. That pressure increase within the eye can lead to glaucoma, a condition that normally brings pain, blank spots in your field of vision, and a rainbow effect around lights.
Inflammatory arthritis leads to glaucoma, but so can treatment for inflammatory arthritis. Corticosteroid use can sometimes lead to pressure within the eye (as well as other eye problems), so be sure to mention any eye issues to your doctor and optometrist right away if steroids are a part of your RA treatment plan.
Cataracts is a condition where the lens of your eye becomes cloudy, leading to blurry vision, colors that seem dull and poor night vision. Changes often happen gradually, so a slight blur becomes a more pronounced problem as the old, damaged cells are compacted under new cell growth on the outside of the lens.
Cataracts are not necessarily painful, but they are problematic. Since the inflammation causes permanent damage to the lens of the eye, the clouded lens must be surgically replaced with an artificial one to restore clear vision.
When to Call the Doctor
Persistently dry eyes may seem like nothing to worry about, but remember a small change in the appearance or sensation of your eyes can be an early warning sign of a much bigger problem. Never wait to see if your irritation or vision changes will clear up on their own: the sooner you can get a diagnosis, the much more likely you’ll avoid permanent damage.
Since certain arthritis medications can increase your chances of developing eye issues (such as prednisone and plaquenil), it’s crucial that you visit your ophthalmologist regularly. Schedule an appointment every six months to make sure no changes in your retina, cornea, or sclera go undetected for too long.