How does rheumatoid arthritis affect the eyes?

Written by daisy mccarty
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How does rheumatoid arthritis affect the eyes?
(Image courtesy of cc license by flickr user Jen Carole; http://www.flickr.com/photos/jcarole/2291492357/)

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Overview

Rheumatoid arthritis (RA) is an inflammatory condition that causes chronic pain. According to the Centers for Disease Control and Prevention, almost 1.3 million adults in the U.S. were suffering from RA in 2005. Women are more than twice as likely as men to develop this disease. Joint pain, fatigue and impaired mobility are the most common symptoms. However, a number of different eye problems can also occur as a result of this illness. These are usually linked to the systemic inflammation caused by RA.

Keratoconjunctivitis Sicca

This dry-eye condition affects approximately 25 per cent of RA sufferers. It reduces the function of the lacrimal (tear) glands. Keratoconjunctivitis can cause inflammation and irritation of the cornea and conjunctiva (the lining on the inside of the lids and on the white of the eye). Symptoms include redness, itching and the sensation of a foreign object being in the eye. The symptoms are often worse during the latter part of the day. This condition is frequently linked to Sjogren's Syndrome, an autoimmune disorder that sometimes occurs along with rheumatoid arthritis.

Uveitis

The uvea is the portion of the eye that includes the iris, the choroid (eyeball lining) and the ciliary body (the movement control centre for the lens). These areas can become inflamed as a result of RA. The early stages of this condition are often free of pain, blurred vision or redness. This means the condition can be difficult to detect. Left untreated, uveitis can result in vision deterioration, scarring and blindness. Uveitis is a frequently reported in cases of juvenile idiopathic arthritis (rheumatoid arthritis in children).

Scleritis

General inflammation of the sclera (the white part of the eyeball) can occur as a result of RA. Scleritis is usually quite painful, and requires treatment using corticosteroids and other anti-inflammatory drugs. Episcleritis is a related condition that affects the protective membrane of the sclera. It is treated in a similar manner, and may also be soothed with prescription eyedrops.

Glaucoma

Untreated inflammation of the eyes caused by RA can result in improper drainage. This disruption of the tear glands and ducts may eventually lead to glaucoma. Symptoms of this condition include blurred or impaired vision and eye pain. Vision loss may continue over time and eventually lead to blindness. Surgery is sometimes necessary to reverse the effects of glaucoma.

Drug Side Effects

Cataracts occasionally develop as a side effect of long-term use of RA medications like corticosteroid eye drops. Ironically, such steroids are often prescribed to reduce the inflammation and other painful eye symptoms RA tends to cause. Cataracts are characterised by clouding of the cornea, resulting in a dim or blurred visual field. The damaged lens must be surgically removed to correct this condition. Hydroxychloroquine is another rheumatoid arthritis drug that can cause vision loss as a rare but serious side effect.

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