How Does Rheumatoid Arthritis Affect Your Eyes?

Rheumatoid arthritis or RA is an autoimmune disease when your immune system attacks the tissues in the joints mistakenly. This results in an inflammation that leads to painful and swollen joints. However, this inflammation can also affect other parts of your body, including blood vessels, skin, and even eyes. In this article we will read about rheumatoid arthritis and how does it affect your eyes.

How Does Rheumatoid Arthritis Affect Your Eyes?

Rheumatoid arthritis is caused because of your immune system misfiring. Rheumatoid arthritis is an inflammatory autoimmune condition that commonly causes joint pain and inflammation. However, it can also affect your eyes and other parts of the body. Rheumatoid arthritis might cause eye complications like dry eyes, redness of eyes, eye pain, uveitis, scleritis, episcleritis, and many more. Read on to know how does rheumatoid arthritis affects your eyes.

Keratoconjunctivitis Sicca Or Dry Eyes:

Keratoconjunctivitis sicca is also known as dry eye syndrome. This is a common eye complication related to rheumatoid arthritis.(1) This condition occurs when your eyes cannot produce enough tears. While there are many conditions that might result in dry eyes, Rheumatoid arthritis and a condition known as Sjorgren’s Syndrome, are the two most common causes.(2)

Dry eye syndrome causes mild to severe symptoms, which include eye irritation, dry eyes, a feeling of grittiness in the eyes, redness of eyes, and blurred vision. Apart from these, your eyes might water more than usual. The symptoms get worse after your read, sleep, or watch TV or computer. Moreover, low humidity, wind, and air conditioning can also worsen your symptoms of dry eyes.

Among those having Rheumatoid arthritis, dry eye is more common in women with Rheumatoid arthritis. You should treat the condition to avoid the risk of eye infection or any damage to your cornea. The condition can be managed effectively with proper treatment and treating the underlying causes.

Redness Of Eyes:

Redness in your eyes can also be one of the ways rheumatoid arthritis affects your eyes. Redness of eyes along with Rheumatoid arthritis is most likely caused due to scleritis, which is an inflammation in the white part of your eyes.

Scleritis can also cause pain in the eyes, reduced vision, and light sensitivity. Redness of the eyes caused due to scleritis does not go away using eye drops.

Scleritis:

Some people with Rheumatoid arthritis might develop Scleritis, especially in adults between the ages of 40 to 70 years of age.(3)

Symptoms of scleritis can appear as continuously red eyes, deep pain in the eyes, and light sensitivity. Scleritis could be dangerous because an injury to the eyes might result in thinning eyeballs to split open.

Scleritis could be a painful condition that might result in partial or complete loss of vision if not treated properly. This inflammatory condition of eye affects up to 6% of people with rheumatoid arthritis.(4) Scleritis is more common in individuals between age of 40 years to 70 years.

Episcleritis:

One more way how rheumatoid arthritis affects your eyes, is by Episcleritis. This is the condition that refers to an inflammation of the episcleral or the clear layer on the top of the white part of your eyes (sclera). There is a redness in the eyes and eye irritation because of Episcleritis.

Episcleritis is the 2nd most common complication of eyes due to Rheumatoid arthritis, and it is believed to affect around 5% of people having rheumatoid arthritis.(5) This might occur at any stage of rheumatoid arthritis, however, it is common during times when a person with rheumatoid arthritis is experiencing high levels of inflammation. One must note that most cases of Episcleritis are limited to just one eye.

Episcleritis may resemble the pink eye. However, it does not cause any discharge from your eyes. This inflammatory condition of the eyes tends to clear up on its own without any treatment.

We must mention that there are 2 types of episcleritis, namely Diffuse and Nodular. They are slightly different from each other. Diffuse Episcleritis results in redness in one part of your eye or throughout the eye with mild discomfort. This condition affects 70% of people with Episcleritis. Nodular episcleritis results in slightly raised bumps surrounded by dilated blood vessels, which are usually in one part of the eye. About 30% of people are affected by this type of Episcleritis.

Both these types of Episcleritis cause similar symptoms like sensitivity to bright light, a hot and prickly feeling in the affected eye, and watery or tearing eyes. The symptoms usually do not affect your vision. Most cases of Episcleritis are mild and they resolve within 21 days.

You can use artificial tears to manage the symptoms of Episcleritis. Corticosteroid eye drops along with oral NSAIDs are effective in controlling inflammation of the eyes.

Uveitis:

Uveitis is one more possible eye complication of rheumatoid arthritis. However, this is mostly seen in the juvenile form of the disease.

Uveitis occurs when the Uvea, or the layer between your retina and the white of the eye, gets inflamed. Symptoms of Uveitis include pain, redness, blurred vision, and light sensitivity.

The majority of cases of Uveitis in children are due to Rheumatoid arthritis, known as systemic juvenile inflammatory arthritis. Uveitis is treatable, but if ignored, it can result in blindness.

Sjogren’s:

Sjogren’s is one type of autoimmune disorder and can develop alongside Rheumatoid arthritis. This condition affects the glands in your body that produce moisture, and this can result in itchy and dry eyes, along with a gritty feeling in the eye, as if sand is trapped in your eyes. As a reaction to the dryness in the eyes, there might also be excessive tearing or watery eyes.

Sjogren’s can also result in some other symptoms like dry mouth and increased cavities, difficulty speaking or swallowing, mouth sores, hoarseness, dry and cracked skin, fever, fatigue, swollen glands and joints, chronic cough, and GERD.

Corneal Damage:

You should treat your condition if you have rheumatoid arthritis and eye symptoms. If left untreated, dry eyes, uveitis, scleritis, or Sjogren’s can cause your cornea to become scarred, scratched, or ulcerated. Corneal damage can result in permanent loss of vision.

Floaters:

Rheumatoid arthritis can also affect your eyes by causing floaters. Various eye inflammation, including Uveitis, can result in floaters that are dark spots that move across your field of vision.

Retinal Vasculitis:

One more way how rheumatoid arthritis affect your eyes is by causing Retinal Vasculitis. Retinal vasculitis is the condition that occurs when inflamed and swollen blood vessels damage the back surface of your eyes where light hits and your nerve endings “read” what you are seeing. You cannot know that there is something wrong until you experience a loss of vision. Mild areas of vision loss or even complete loss of vision or blindness can occur suddenly.

Peripheral Ulcerative Keratitis Or PUK:

Peripheral Ulcerative Keratitis or PUK is a rare, yet serious condition that involves inflammation of the blood vessels in the eyes or ulceration in the cornea of your eye.

Symptoms of this eye condition are quite similar to those of Scleritis and Uveitis and include pain, redness, and sensitivity to light. However, PUK can also result in blurred vision. Sometimes people with Peripheral ulcerative keratitis complain that things look fuzzy due to swelling, that can distort the lens of the eyes.

Medication Complications:

Some of the medications, which are used for treating Rheumatoid arthritis like Prednisone or a Corticosteroid and Plaquenil or Hydroxychloroquine, can trigger several eye problems. On rare occasions, Plaquenil can result in retinopathy, which is an inflammatory disease of the retina of your eyes that can result in impairment or loss of vision.

Prednisone can also cause Glaucoma or cataracts, or worsen these conditions(if you have them already).

Long-term use of Plaquenil can found to damage the retina, which leads to serious loss of vision.(6)

If you are taking medicines that have side effects that can impact your eye, you should consult with an ophthalmologist who can monitor for any adverse effects. To rule out retinopathy, patients who are using Plaquenil must consult their eye doctor every year.

Diagnosis Of Eye Problems Related To Rheumatoid Arthritis:

Your doctor would ask questions related to your medical history and symptoms. They would also take a close look at your eyes. In certain cases, your doctor might take a small sample of fluid, pus, or any other material from your eye.

You might require an ophthalmologist to pinpoint the problem of your eye. A rheumatologist may help assess your condition of rheumatoid arthritis. Your doctors can figure out the best treatment for you as per your symptoms and severity.

Treatment Of Eye Problems Related To Rheumatoid Arthritis:

Early eye detection is important for your treatment of Rheumatoid arthritis. When the condition of RA is detected and treated early and the inflammation is reduced, you will be less likely to develop eye disorders caused by Rheumatoid arthritis.

Using eye drops, warm compresses, and topical lubricants, you can treat your eye complications. These treatments can help in relieving redness, dryness, and itching. The best eye drops are those drops without preservatives.

For severe cases of inflammations that do not respond to eye drops, you should consult with your doctor. They would recommend you a topical steroid or immunosuppressive medications. They are basically applied twice a day for treating the underlying inflammation.

Does Your Eye Problem Mean You Have Rheumatoid Arthritis?

If you experience red eyes or dry eyes, it is possible that you might have an autoimmune disorder, such as Rheumatoid arthritis or RA with Sjogren’s. However, several other conditions can also result in dry eyes or red eyes.

If along with symptoms of eye problems, you have painful joints, fatigue, flu-like symptoms, general weakness, and unintended weight loss you will be having Rheumatoid arthritis. You should talk to a doctor if you experience the symptoms.

Final Words:

Rheumatoid arthritis is a disease that results in inflammation of your joints. However, it can also spread to other organs, including the eyes. We talked about some of the ways how rheumatoid arthritis can affect your eyes. You should treat the condition and also the eye complications associated with it. Make sure that if you have RA, you should visit your eye doctor to examine your eyes from time to time to help identify any eye complications early. This is because chronic dry eyes and various other complications of the eye can lead to corneal damage that might cause a permanent loss of your vision. Your doctor would be able to provide you the appropriate treatment for the eye complications and offer you proper eye relief.

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