Doctor - I Have Rheumatoid Arthritis And My Eyes Hurt. How Does Rheumatoid Arthritis Affect The Eyes?

By Nathan Wei

While the most obvious symptoms of rheumatoid arthritis have to do with joint swelling and pain, there are multiple other problems that may occur that an arthritis specialist has to be constantly vigilant for.

For instance, rheumatoid arthritis can cause damage to the lungs and heart and be associated with significant damage to the skin and nerves. Also, it can cause serious problems with the eyes.

There a number of eye conditions that can be associated with rheumatoid arthritis and its treatment. These include:

• Dry eyes. This condition is often a tip-off that Sjogren's disease, a common autoimmune condition coexists with the rheumatoid arthritis. Generally, patients with rheumatoid arthritis who also have Sjogren's disease have a more severe course of disease and prognosis.

• Inflammation of the inner part of the eye (uveitis). This condition often causes symptoms such as eye redness, eye pain, and tearing. If not treated it can lead to blindness.

• Inflammation of the episclera (episcleritis), the surface membrane covering the white part (sclera) of the eye. This condition shows up as a red eye. Sometimes tearing and irritation can occur. While not as severe as uveitis, it must also be treated aggressively.

• Cataracts. These often develop as a result of chronic steroid therapy. The treatment is the same as for routine cataracts. Steroid dose should be minimized when possible.

• Maculopathy. This is damage to the retina of the eye. Most often associated with anti-malarial therapy for rheumatoid arthritis, it is exceedingly rare nowadays. Still… patients who receive either hydroxychloroquine or chloroquine for their rheumatoid arthritis need to be evaluated on a regular basis (usually every six months) by an eye physician to check for this side-effect.

Treatment of dry eyes may include artificial tears and other eye lubricants. Patients who also have dry mouth can be treated with artificial saliva and mouth moisturizing agents. In addition, pilocarpine can be used. This drug should not be used in patients who also have glaucoma. Sometimes patients who are unresponsive to more conservative measures may require surgery.

Treatment of uveitis and episcleritis may include corticosteroid eye drops, cyclopegics (dilating drops), and anti-inflammatory medications. Often more aggressive systemic therapies are needed. In fact, the presence of significant eye inflammation in the form of uveitis, episcleritis, or Sjogren's disease should be a warning signal that a more aggressive approach is needed.

Patients who have rheumatoid arthritis and experience dry eyes, eye pain or redness, blurred vision, excessive tearing, or light sensitivity, should see an ophthalmologist for evaluation immediately. Close and careful consultation with a rheumatologist is strongly advised.

About the Author: Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment

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