Arthritis is most commonly thought of as inflammation causing swelling and pain in the joints. But the condition can cause problems in other, more unexpected areas of the body, including the eyes. Arthritis is a chronic disease which can affect people of any age, race or gender. Women experience more arthritis-related eye problems than men do.
TYPES OF ARTHRITIS
There are about 100 different forms of arthritis and related diseases, including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, fibromyalgia and gout. The most common types linked with eye problems are rheumatoid and psoriatic arthritis. Rheumatoid arthritis is an autoimmune disease which attacks the connective tissue lining the joints. This connective tissue is made up mostly of collagen, which is the primary substance of the sclera and cornea of the eye. Psoriatic arthritis is an inflammatory condition which can affect connective tissue.
Juvenile or childhood arthritis, as the name suggests, is an umbrella term to describe the many autoimmune and inflammatory conditions that can occur in children aged 16 or younger. The exact cause is unknown, but it is believed to be related to genetics, certain infections and environmental factors. Although the various types of juvenile arthritis share common characteristics, each type is distinct and has its own special concerns and symptoms. Juvenile arthritis, also called juvenile rheumatoid arthritis or childhood arthritis, can affect many parts of the body, including the eyes. The problems may be caused by the disease itself or by medications the child takes to manage the disease. Children with juvenile arthritis should have regular eye examinations as symptoms of visual problems may not be apparent until they are advanced. Early detection is the key to the best possible outcome.
EYE PROBLEMS LINKED WITH ARTHRITIS
The hallmark of arthritis is inflammation which can lead to various eye conditions:
Dry Eye Syndrome
Many people who have arthritis also suffer from dry eye, a condition characterised by reduced tear production and/or poor tear quality. Women are more likely than men to have dry eye syndrome with arthritis. Symptoms may include a sensation of something in the eye, blurred vision, increased sensitivity to light and watering of the eyes. If left untreated, dry eye is not only uncomfortable but can lead to infections and corneal scarring. People with dry eye may need to use an ointment, artificial tears, or eye drop medication to help keep their eyes moist. Tiny plugs, called punctal plugs, are sometimes inserted in the tear ducts to help keep tears on the eye surface.
Scleritis
Some people with arthritis, particularly older people, may develop scleritis, inflammation of the sclera, the white part of the eye. The inflammation thins the sclera and can become dangerous. Scleritis symptoms can appear as continuously red eyes despite using eye drops, deep eye pain and light sensitivity. It is often an indication that the inflammation in the body is out of control, requiring adjustment to the arthritis medication to reduce the inflammation.
Uveitis
Uveitis is inflammation of the uvea, the vascular layer of the eye found between the retina and the sclera and including the iris, the coloured part of the eye. Eye pain, light sensitivity, blurred vision and redness are symptoms of uveitis. There is a risk of permanent vision loss, particularly in children with psoriatic arthritis, who should be screened regularly for uveitis as symptoms may not be present until there is vision damage. Steroid treatment may help control scleritis and uveitis inflammation. However, it is important to note that one of the side effects of steroid use can be other eye problems.
Cataracts
A cataract is the clouding of the eye's naturally clear lens, resulting in cloudy or blurred vision, poor night vision and the perception that colours seem faded. Long term use of steroid medication to treat arthritis can increase the risk of developing cataracts. Surgery is usually performed to remove the cloudy natural lens and replace it with an artificial lens to improve vision.
Glaucoma
Glaucoma is damage to the optic nerve that usually occurs due to high pressure inside the eye. When the channels that usually drain fluid from the eye become inflamed due to arthritis, eye pressure builds up, gradually damaging the optic nerve and eventually causing vision loss. Glaucoma can also develop as a side effect of corticosteroid treatment for arthritis. Because glaucoma has no symptoms in its early stages, regular eye examinations are essential to detect the condition and begin treatment early. Later symptoms may include blurred vision, halos around lights and blank spots in the field of vision. Eye drop medication can help reduce eye pressure. Sometimes surgery may be needed to help improve the flow of fluid from the eye.
Conjunctivitis
Arthritis is a risk factor for conjunctivitis, an inflammation or infection of the lining of the eyelids and the white of the eyes. The symptoms include itchy or burning eyes, watery eyes, eye redness and a yellow discharge that crusts around the eyes. It is usually treated with antibiotic eye drops and sometimes steroid drops to reduce inflammation.
Like adults, children with arthritis are at risk of developing these eye conditions, due to the arthritis itself or the ongoing long-term treatment of the disease.
CONTROL INFLAMMATION
As well as monitoring and managing inflammation throughout the body, people with arthritis should have their eyes checked regularly for early detection of problems and protection of the eyes against further damage.