Types of Ocular Rheumatoid Arthritis

Rheumatoid arthritis, a widely diagnosed autoimmune disease, can trigger a wide variety of vision problems that range from red and dry eyes to complete loss of vision in one or both eyes. Doctors and patients must be alert to manifestations of rheumatoid arthritis so that they can be treated in a timely fashion to avoid permanent damage to patients' vision.

Cause of Rheumatoid Arthritis

• The cause of rheumatoid arthritis is unknown, according to MedlinePlus. It is an autoimmune disease, one of several that are characterized by attacks by the immune system against one or more parts of the body. Although this disease is most often associated with painful inflammation of the joints and adjacent tissue, it can show up in other parts of the body, including the eyes.

Vision Manifestations

• In an article in the Sept. 15, 2002, issue of American Family Physician, Lt. Sayjal Patel and Capt. Diane Lundy, both of whom were serving at the U.S. Naval Medical Center in San Diego, examined ocular manifestations of autoimmune diseases, including rheumatoid arthritis. Manifestations linked to rheumatoid arthritis include choroiditis, episcleritis, episcleral nodules, keratitis, keratoconjunctivitis sicca, macular edema, retinal detachments, retinal vasculitis, scleritis and ulcerative keratitis.

Significance

• The eye-related manifestations of rheumatoid arthritis are not to be taken lightly, as several of the conditions listed by Patel and Lundy eventually can result in a visual impairment or total loss of vision. In an article written for the UpToDate website, M. Reza Dana, M.D., points out that "ocular involvement, in particular severe dry eye, may exist independently from severe articular disease, and should be evaluated in all patients with RA (rheumatoid arthritis) regardless of extra-ophthalmic manifestations."

Signs of Ocular Involvement

• The telltale signs of keratoconjunctivitis and keratoconjunctivitis sicca, according to the Johns Hopkins Arthritis Center, are red, inflamed and/or dry eyes, while episcleritis causes mild pain and extreme redness of the affected eye(s). Less commonly seen, but far more serious are scleritis, an inflammation of the white of the eye, and ulcerative keratitis, which causes extreme pain, blurry or impaired vision, tearing and pronounced squinting. Signs of retinal vasculitis may include blurred vision, a change in color perception, blind spots and floaters, while retinal detachments may be signaled by floaters, blurred vision and flashes of light.

See Your Ophthalmologist

• Even the mildest of these ocular forms of rheumatoid arthritis eventually can cause vision problems if left untreated. If you are experiencing any of these symptoms, regardless of whether you've been diagnosed with rheumatoid arthritis, see your ophthalmologist promptly so that he can begin treating these disorders before they progress to more serious symptoms.