How Does Rheumatoid Arthritis Affect the Eyes?

We know clearly that RA (rheumatoid arthritis) is an autoimmune disease. The inflammation can be systematic. In other words, it is not only about the joint, it can affect other parts of the body, including the eyes. It could cause several types of eye problems.

How does RA affect the eyes?

Like other things in arthritis, RA is primarily thought of a joint condition. However again, since it is related to the abnormality of the immune system, there is a chance for it to cause complications in other parts of the body.

image_illustration278One of these is eye problems. The immune system abnormality in RA could cause inflammation in some parts of the eyes, causing dryness, pain, or in severe case might lead to loss of vision.

Each eye problem has its own cause to occur. In those related to RA, they occur when the abnormality of immune system leads to inflammation or other problems in certain part of the eyes.

Dry eye syndrome

In general, we probably only find our tears when we cry or laugh out loud. But actually both of your eyes continuously produce the tear that is always used to cover and lubricate your eyes.

The tear is also essential to protect the eyes from infection, dust, or other harmful things. Although water is the most major component, but it is also made up of some fatty oils, mucus, salts, or even protein. Each of these components has unique function to help make the tear not easy to evaporate and spread the tears evenly over the eye’s surface.

tear_in_dry_eye_syndrome

*Image credit to aoa.org

When the production of the tear is disrupted, this can affect both the quantity and quality of your tears. And it can be disrupted in some way.

In some cases, rheumatic arthritis affects the glands around the eyes, too. This leads to the disruption in the eye’s complex tear production process, making your eyes not produce enough tears and causing dryness.

Symptoms

This eye problem is also called as keratoconjunctivitis sicca, the most common dry eyes. It is typically characterized by the following symptoms:

  1. Dryness that may be followed with soreness. They may get worse throughout the day.
  2. Changes in color of the eyes, red eyes.
  3. In the morning when you wake up, your eyelids can stick together.
  4. You may experience blurred vision, too. But it usually resolves when you blink.

Additionally, sufferers may also have other discomfort symptoms such as scratchy, irritated, or gritty eyes. In severe case, the problem might cause damage to the front surface of the eye.

Causes

Dry eyes in RA are usually associated with the condition of when the eyes are lack of tears. This may occur when the inflammation of RA affects certain parts of the eyes involved in producing and controlling the tears.

The glands that make tears are called lacrimal glands, located above the eyes. They continuously make tear fluid. And each time you blink, the tear is wiped across the surface of the eyes. The excess tears will naturally drain through the ducts that line to the nose.

tear_gland_to_produce_tears_of_the_eyes

*Image credit to Mayo

RA is not the only one of health condition associated with dry eye syndrome. The problem is also more likely to occur in people with the following conditions:

  1. Sjogren’s syndrome, a condition typically characterized by dry mouth or/and dry eyes. It is an autoimmune disease, too.
  2. Other autoimmune disorders such as lupus and HIV.
  3. Allergic conjunctivitis, an allergic reaction that causes inflammation and redness of the conjunctiva (a thin, transparent layer that covers the front of the eye).
  4. Contact dermatitis, a skin problem.
  5. Previous traumatic condition that affects the eyes, such as getting excessive exposure to radiation or burns.
  6. Bell’s palsy, it is a condition that can lead to weakness or even paralysis. It usually affects the muscles of the face at one side.
  7. Scleroderma, a rare disease that can lead to hardened skin since it involves the tightening & hardening of the skin and connective tissues.

If it has nothing to do with certain health condition, it is more likely associated with the following causes:

  1. Environmental factors that trigger your tears evaporate quickly, such as exposed to dry climate, windy, hot blowing air, or high altitude.
  2. Lifestyle factors, such as the use of poor contact lenses.
  3. The side effect after taking certain medication, such as laser eye surgery, diuretics, antidepressants, etc.
  4. Age! Yap, the performance to produce tears decreases as the age. Therefore, dry eye syndrome occurs more often in elderly people.
  5. Hormonal changes! Hormones in the body play a key role for lots of body functions. And some of them are essential in controlling the production of tear. Hormonal changes such as in menopause and pregnancy can increase the risk of dry eye syndrome.

Prognosis and outlook

In general, dry eye syndrome is not serious, particularly true if it is not linked to an underlying condition or only associated with lifestyle /environmental factors. However if it get worse or lasts longer than what you think, see a doctor for the best advice and treatment!

The treatment options include medications to treat the inflammation, eye drops to help provide additional lubrication and ease dryness, certain medications to help increase the tear production, or even surgical-treatment option if necessary.

If the problem is linked to certain health condition, treating the cause (the health condition behind the problem) will usually improve it. For instance, if it is triggered or caused by RA, it’s also important to treat and control RA to help resolve the symptoms of the dry eye syndrome.

Restasis is one of common approved medicines for dry eye syndrome linked to RA. This eye drop contains cyclosporine, an immunosuppressant that can help control T-cells (overactive T-cells can worsen the inflammation in people with RA). But it is usually not prescribed if there is an infection or if you have allergic reaction to cyclosporine!

Along with the prescription medications, the following self-cares are also helpful:

  1. Mostly, your eyes will naturally blink for several times in every few seconds (typically about 15 times per minute). But when you do certain activity (such as when seeing a computer screen or reading for long periods of time), the frequency to blink may decrease. As such, these activities may make the problem of your dry eyes worse – remember to always blink your eyes regularly! It is also much better to take a break every 20-30 minutes to allow your eyes get a rest for a few seconds.
  2. Keep the humidity of your room comfortable!
  3. When you need to do an outdoor activity, wear sunglasses with wrap around frame design. This can help reduce the excessive exposure to drying sun and wind.

Some supplements such as those containing essential fatty acids may help for coping. But to make sure that your choice is safe, ask your doctor first!

Scleritis

Another eye problem related to rheumatoid arthritis is a condition called as scleritis. It is a condition of when the inflammation occurs in the sclera (visible, white outer wall ‘white area’ of the eye).

The sclera is composed of connective tissue, making a protective layer for the eyes. A thin layer called episclera masks the front part of the sclera. In front of episclera, there is another layer called conjunctiva (transparent layer).

sclera_of_the_eye

*Credit to Adam Images

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