Systemic rheumatic diseases are often associated with eye disorders. As with many of the rheumatic diseases, the eye diseases involve inflammation that can affect different parts of the eye and cause different types of vision problems. Treatment and management of these ocular manifestations of the rheumatic diseases are important because many of the eye diseases can be treated, and if treated properly, vision can be spared, according to Natalie A. Afshari and colleagues in a 2007 article in the "Current Rheumatology Reports" journal.
Rheumatoid Arthritis
The chronic inflammatory disease rheumatoid arthritis generally affects the small joints in the hands and feet. According to the Mayo Clinic, these patients may develop dry eyes, which can be managed with artificial tears. Patients with rheumatoid arthritis can also develop inflammation of the white part of the eye or scleritis, which causes significant pain, as well as the thin clear covering over the white part, or episcleritis, which causes redness and eye discomfort. The patient may also develop inflammation inside of the eye, called uveitis. As a result of the intraocular inflammation or the medications used to treat it, some patients develop cataracts or glaucoma.
Temporal Arteritis and Polymyalgia Rheumatica
Temporal arteritis and polymyalgia rheumatica are separate rheumatic diseases, but often occur together, according to the Merck Manual. Temporal arteritis, which is inflammation of the arteries on the side of the head, can cause double vision, partial loss of the visual field or complete loss of vision in one eye. Symptoms include headaches and pain in the jaw when chewing. Prompt diagnosis and treatment may prevent permanent loss of vision; if not treated, this condition can spread to both eyes.
Systemic Lupus Erythematosus
The rheumatic disease, systemic lupus erythematosus, or SLE, is an autoimmune disorder whereby the body's own immune system attacks the body itself; while the lungs, heart, blood vessels, skin and kidneys are most often affected in SLE, the eyes can be affected, as well. According to the American Optometric Association, a patient with SLE may develop dry eye syndrome or scleritis. These patients may also develop inflammation of the blood vessels in the retina, which can lead to damage to the retina and loss of vision. Patients with SLE may also develop damage to the nerves supplying the eye, causing double vision, ptosis of the eyelid, or inflammation of the optic nerve itself.
Wegener's Granulomatosis
According to an article on the American Uveitis Society website, Wegener's granulomatosis involves inflammation of the blood vessels, the kidney and the respiratory tract, and about one-half of patients with develop associated ocular diseases. These patients can develop a blockage of the tear duct, and a more serious condition involving inflammation of the orbit whereby the tissues around the eyes, including the muscles, can cause eye protusion, double vision and loss of vision. These patients can also have scleritis or uveitis.
Adamantiades-Behcet's disease
Adamantiades-Behçet's disease which is also known as Behçet's disease is a rheumatologic condition that involves systemic vascular inflammation with genital ulcers, skin lesions and uveitis. According to an article by Christos C. Zouboulis, these patients develop inflammation in the front of the eye--anterior uveitis--and in the back part of the eye--posterior uveitis. Patients can also develop retinal vasculitis, which is inflammation of the vessels in the retina. As noted in this article, about 20 to 40 percent of patients with Behçet's disease can go blind, so prompt treatment with immunosuppressive medications like azathioprine or corticosteroids is important.
References
- "Current Rheumatology Reports"; Inflammatory Conditions of the Eye Associated with Rheumatic Diseases; Natalie A. Afshari, Mehran A. Afshari and C. Stephen Foster; 2007.
- Mayo Clinic: Rheumatoid Arthritis - Can Rheumatoid Arthritis Affect the Eyes?
- Merck Manual: Temporal Arteritis and Polymyalgia Rheumatica
- American Optometric Association Systemic Lupus Erythematosus and the Eyes
- "The American Uveitis Society"; Wegener's Granulomatosis; Roxana Ursea, MD, Robert B. Nussenblatt, MD, and Ronald R. Buggage, MD; 2003.
