If you suffer from arthritis, you know that it not only affects your joints but also other connective tissues in your body.
This post looks at what effect arthritis can have on your eyes and how to manage it.
Why the eye?
The eye is completely different to your other organs, in that it contains transparent tissues (the cornea and lens) and other connective tissues that are not found elsewhere in the body. Your sclera (white of your eye) and crystalline lens are made almost entirely of collagen – the tissue attacked by some forms of arthritis. This is why arthritis can have such a devastating effect on your eyes.
Dry eye disease
Dry eye disease is one of the most common associations with rheumatoid arthritis. Dry eyes are also the major symptom of Sjogren's syndrome, an autoimmune disease associated with arthritis that reduces secretions from the tear glands and salivary glands. Chronic use of arthritis medication can also result in dry eyes.
These factors mean that the eye cannot maintain a protective layer of tears on its surface. This in turn leads to the symptoms of dryness, irritation, foreign body sensation and redness that are associated with dry eye syndrome.
There are many successful treatments for dry eye disease, depending on the underlying cause. You don't have to just put up with it. The Eye Practice leads the way when it comes to managing moderate-to-severe dry eyes.
Plaquenil and your retina
Plaquenil is a drug used to treat rheumatoid arthritis. In some people, use of this medication can lead to a type of retinal disease called hydroxychloroquine retinopathy (or bull's eye maculopathy, due to the target-shape of the affected area of your retina). This often starts as a disturbance in your peripheral vision but can progress to devastating - and often permanent - loss of central vision.
If you are starting Plaquenil, you should have a baseline taken of your visual field (peripheral vision). Currently, it is recommend that Plaquenil users have the following eye tests at regular intervals:
- dilated pupil retinal exam
- central visual field
- retinal imaging - photography and OCT
Your risk of developing retinal damage from Plaquenil depends on a number of factors including age and whether you have any other retinal disease. You eye specialist will advise you how often to have these tests.
Cataract eye disease
Arthritis sufferers get the double whammy when it comes to cataract eye disease. This is where the clear, crystalline lens inside your eye becomes cloudy, resulting in poor vision, fading colours and increased glare.
Not only does rheumatoid arthritis (and other forms such as ankylosing spondylitis) cause inflammation of the lens inside your eye, but the common treatments for arthritis – cortico-steroids and non-steroidal anti-inflammatory drugs – can also cause cataract.
The good news with cataract is that it is treatable with microsurgery and generally has excellent results. Arthritis can make cataract surgery more complicated for the surgeon, particularly if the fibres that hold your natural lens in position are damaged by your disease. It is always best to seek a cataract surgeon who is experienced in inflammatory eye disease.
Glaucoma is a disease of the optic nerve at the back of your eye. It is often caused by increased pressure in your eye can also result other causes such as reduced blood flow to the nerve.
Arthritis can lead to glaucoma indirectly through several means. Uveitis can cause marked increased in pressure within the eye through inflammation in the structures that allow fluid to leave the eye.
The mainstay of treatment for arthritis – anti-inflammatory drugs – can also lead to increased intra-ocular pressure and ultimately, glaucoma. This is one reason why your rheumatologist has to carefully weigh up the pros and cons of steroid use to control your disease. Cortico-steroids are used at the lowest dose and duration that can manage the disease.
There is no one test for glaucoma. Your optometrist should perform a range of diagnostic tests regularly to pick up early signs of this potentially sight-threatening disease.
Tests include measuring:
- intra-ocular pressure at different times of the day
- central corneal thickness (thinner corneas are associated with a higher risk of glaucoma)
- visual fields (peripheral vision is first to be affected by glaucoma)
- volume and profile of optic nerve tissue
Glaucoma is often called the silent thief of sight due to having no symptoms until permanent damage has occurred. If you have arthritis however, you may also get a more symptomatic glaucoma, with eye pain, coloured halos around lights and blurred vision.
The mainstay of glaucoma treatment is pressure-lowering eye drops. Laser and surgical treatments may also be required. If you have arthritis in your hands, a laser or surgical procedure that reduces or eliminates your need for daily eye drops can be very beneficial.
The coloured part of the eye – or iris – is made of muscle, and it too can become inflamed as a result of arthritis. This is called uveitis (which affects the iris and the thin muscular layer of the eye) and requires prompt and aggressive treatment to limit permanent damage to your eyes.
Symptoms include pain, which can be severe, sensitivity to light, blurred vision and a ring of redness surrounding the coloured part of your eye.
Although uveitis can appear in an otherwise healthy person, it can often be the first sign of arthritis and new cases of uveitis will be tested to rule out a range of inflammatory diseases such as ankylosing spondylitis and other forms of arthritis.
Staying on top of your arthritis is the best way to avoid uveitis. Steroid eye drops are the first line treatment but sometimes steroid injections or tablets may be required. At hte first sign of uveitis, see your rheumatologist or eye specialist.
Rare but serious
Rarer conditions such as scleritis and retinal vein or artery occlusion are associated with some of the rarer forms of arthritis. If you have been diagnosed with any form of arthritis (see above) you should see a therapeutically endorsed optometrist regularly. If there are ocular signs of disease, they will refer you to an ophthalmologist who specialises in inflammatory eye disease.
Scleritis is a rare but serious condition where the whole eyeball wall becomes inflamed. It is difficult to treat and is usually a sign that your arthritis is out of control.
Symptoms include redness and a deep, boring ache with severe pain. The pain can be very severe as the nerves that pass through the wall of the eyeball are compressed due to inflammation going on around them.
Retinal artery occlusion is a blockage in one of your major retinal blood vessels and can result in permanent loss of vision. Blockage in a retinal vein can sometimes be treated. Always seek urgent assistance if you experience any sudden, painless loss of vision. This can occur in many diseases that affect the blood vessels including several inflammatory diseases such as lupus, sarcoidosis and scleroderma.
Tips for using eye drops if you have arthritis
Inflammation and disfiguration of your hands can really affect your ability to instil eye drops. Here are a few tips from The Eye Practice:
- If you suffer from dry eyes or Sjogren’s Syndrome, there are some very effective lubricating and hydrating products that you can spray at your eyes rather than having to accurately aim a dropper. Check out Hylo Fresh and Hylo Forte, which feature a valve delivery system.
- Pharmacies stock a selection of eye drop dispensers that can make instilling drops a lot easier.
- AutoSqueeze (pictured) is a simple apparatus that allows easy use of eye drop bottles and is readily available online.
- If you have been prescribed anti-glaucoma drops, talk to your eye specialist about combination drops and / or laser and surgical procedures which may eliminate or greatly reduce your need for daily eye drops.