How does rheumatoid arthritis put your eyesight at risk?
19 August 2021
Does rheumatoid arthritis impact your vision?
Rheumatoid arthritis (RA) is an autoimmune condition which usually affects your hands, wrists and feet, causing pain and swelling. With RA, your immune system attacks your joint tissues mistakenly and can also attack your skin and blood vessels. The inflammatory response of the misfiring immune system can cause a variety of other symptoms. Although arthritis is mostly associated with joint problems, RA also commonly impacts your eyes, leading to loss of vision if left untreated over a long period. Often, it’s not RA itself but rather the medications used to treat RA that causes eye issues. A popular RA treatment, Plaquenil, has been known to trigger retinopathy, while another, prednisone, has been found to lead to cataracts and glaucoma in some cases.
Symptoms of RA typically are:
- Fatigue and weakness
- Achy or painful joints
- Flu-like symptoms
- Weight loss
These will usually be accompanied by eye issues such as:
- Dry eyes
- Iritis and uveitis
- Corneal damage
- Retinal vascular occlusion
We’re going to delve into the impacts of RA and discuss the symptoms you need to watch out for to know when to seek treatment. As with most eye diseases, the sooner you identify the issue and treat it, the better the chances are of preserving your vision.
Which eye conditions are caused by rheumatoid arthritis?
Dry eyes are one of the most common problems caused by RA. This is because RA causes inflammation in your eye’s tear glands, reducing fluid output in the eyes. This in turn leads to an itchy, grit-like sensation in your eyes, resulting in a red appearance and occasionally blurred vision. Dry eyes usually can be treated with over the counter eye drops, or punctal plugs and thermoflow treatment in more severe cases. It is important to treat dry eyes as, if ignored, the condition can cause corneal damage.
Scleritis is a condition whereby the whites of your eyes – the sclera – become red and inflamed. You might also experience light sensitivity, blurred vision or eye pain alongside this. Normal hydrating eye drops won’t help this inflammation, so your doctor may prescribe steroid eye drops or immunomodulator medications. If you notice any of the symptoms of scleritis, it’s crucial that you seek medical help as quickly as possible. If left untreated, your vision can worsen beyond repair.
Iritis and uveitis
As we know, the iris is the coloured part of your eye, denoting whether you have green, blue, hazel or brown eyes. The uvea is the middle section of your eye in between the sclera (the white surface of your eye) and the retina (the back of your eye). RA can cause inflammation of both the iris and the uvea, resulting in conditions known as iritis and uveitis. Symptoms can range from dark floaters and blurry vision, to eye pain, light sensitivity and redness. Different treatments can be offered by your doctor, depending on your symptoms and thankfully both conditions are treatable.
Most of us have some kind of floaters in our eyes. Floaters can be spots or squiggles that move across your field of vision, changing direction when you move your eyes. Most of the time, they’re only really noticeable when looking at a bright, plain background such as the sky or a white wall, however in serious cases, they can obscure vision. In RA sufferers, floaters are typically caused by uveitis and other inflammation of the eye. You can read more about floaters and their formation and treatment on our blog.
Cataracts are a very common eye condition, with over half of people aged 80+ having had a cataract at some point in their lives. Cataracts usually develop from the age of 60 onwards and can leave you with practically no vision at all if left untreated. This is because the proteins in the eye clump together with age, first presenting as cloudy vision, poor night vision, or dimmed colours. Over time, this can obscure your vision and, in people with RA, inflammation of the eye can speed up this process. Thankfully, cataracts are easily treatable with cataract surgery, ranked by the WHO as the safest elective procedure. It’s also the most widely-performed surgery in the world, carried out over 18 million times a year.
Glaucoma is a condition where the optic nerve in your eye is damaged by high pressure. In RA patients, the eye’s valve (which release pressure in the eye) can become inflamed and stop working properly, resulting in fluid build-up in the eye. Symptoms of this can include halos around lights, eye pain, blurred vision, or blank spots in your vision. Worryingly, in its early stages, glaucoma usually has no symptoms. This is why it’s vital that you go for regular eye checks, particularly if you suffer with RA. Another typical symptom of glaucoma is worsening peripheral vision, so if you notice this, book an appointment with your optician immediately.
While corneal damage isn’t a direct result of RA itself, several of the other eye issues caused by the condition can lead to scratched, ulcerated or scarred corneas. Dry eyes, uveitis and scleritis are all problems which can affect the surface of your eye, the cornea. Having a smooth, regular cornea is what gives you good vision so any disruption to it can have a hugely negative impact on your sight. In severe cases, corneal damage can also lead to permanent loss of vision, highlighting exactly why it is so important to have the initial eye issues treated, before they progress into something more dangerous.
Retinal vascular occlusion
One of the most serious side effects of RA on your vision is retinal vascular occlusion. The retina is at the back of your eye and is responsible for processing light in order for you to actually see. It has lots of small blood vessels feeding it to keep it healthy and functioning well. RA can cause these blood vessels to become inflamed and blocked, preventing you from seeing. You may experience this in the form of a curtain-like shadow coming over your eye. This is similar to what can happen in strokes which can permanently affect your vision so, again, it’s very important that you’re aware of these symptoms and what to look out for.
You should see your optician or eye doctor every two years anyway, but if you’ve been diagnosed with RA, it’s crucial that you visit them every year. The disease can be fast-moving and, in order to preserve your sight, it’s important to catch any eye conditions occurring as a result of RA very early on. You should also book an eye check-up immediately if you have RA and find yourself experiencing itchy eyes, eye pain or redness, vision loss or a grit-like feeling in the eye. Our vision is perhaps the most important of all our senses, so monitoring and protecting it is vital.
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