Rheumatoid arthritis (RA) is a disease that can affect the entire body, including the eyes. Systemically, RA is associated with joint stiffness, fever, weight loss, and feelings of illness. The disease is labelled as an autoimmune disorder, meaning that the body is essentially attacking itself. There are many ways that the disease can affect the eyes and below are a few of the most common ocular signs.
Dry Eye Syndrome
This is the most common condition associated with RA and presents with burning sensations, blurry vision, or the feeling that something is stuck in the eye. It is often the first sign that arises. The main cause is dysfunction of the glands that produce oil and watery fluid that protect the front surface of the eye. Without this protective tear layer, the eyes will dry out quicker and damage to the underlying tissue will occur, leading to the symptoms described. Treatment for dry eye syndrome includes artificial tears, immunomodulator eye drops, and occlusion of the drainage system for the tears, also known as punctal occlusion.
Episcleritis and Scleritis and Ocular Inflammation
This is an inflammation of the white part of the eye, with sclera referring to the white portion and the episclera being the overlying translucent layer with blood vessels. Inflammation of this part of the eye is associated with localized or diffuse redness, mild to severe pain, and tearing. It is worth mentioning that, usually, episcleritis does not have an underlying cause and scleritis could be associated with other conditions. If this condition is recurrent, our optometrist may refer you for further testing to find the underlying cause. Episcleritis often goes away on its own but if needed, steroids or over-the-counter pain medication can be used for comfort. Scleritis is more complex and treatment can include steroids but is mostly focused on treating the underlying RA.
Peripheral Ulcerative Keratitis (PUK)
In PUK, the outer corners of the front surface of the eye are being attacked by the body, causing a small point of melting. There are other conditions that can cause PUK but RA is the most common reason. It can often occur secondary to scleritis, especially in severe cases. The condition is associated with pain, light sensitivity, tearing, and blurry vision due to changes in the front surface of the eye. Treatment prioritizes managing the underlying RA but can be supported with steroids and immunomodulators.
Rheumatoid Arthritis Medications and Eye Health
Treatment of RA is the most important step to prevent the above conditions. Unfortunately, some of the medication that is used to treat RA could have lasting effects on the eyes if used long term. There are a few medications available but most often, hydroxychloroquine or Plaquenil is prescribed. It is common for patients to be asymptomatic at the beginning stages of the toxicity from this drug. However, some patients complain of color vision changes (specifically red), missing central vision, reading difficulty, halos around lights, and distortions in their visual field. One of the biggest effects this drug has on the eyes are the changes that occur in the macula, the point at the back of the eye where light focuses to produce clear central vision. With special testing, our optometrist will be able to tell if there is irreversible destruction of the nerve tissue. Thus, it is important to be monitored by our optometrist for changes in the health of the eye if currently taking this medication.
Our eye doctor at Innovative Vision Care in Belton, Missouri excels in the prescription of contact lenses, glasses and various eye diseases. Call our optometrist at 816.331.9590 or request an appointment online if you would like to be evaluated for eye health related questions to rheumatoid arthritis. Our eye doctor, Dr. Aaron Law, provides the highest quality optometry services and eye exams in Belton, MO.