How Does Arthritis Affect the Eyes?

Arthritis, which means inflammation of your joints, is a term that describes over 100 conditions affecting connective tissues in your body, including your eyes.

Osteoarthritis is the most common form of arthritis, affecting millions of people. It causes:

• pain
• stiffness
• swelling
• decreased flexibility of the joints

The symptoms come primarily from aging or long-term wear and tear. OA occurs most frequently in the hips, knees, and hands and results from cartilage within a joint breaking down.

OA also occurs more frequently in people with obesity, postmenopausal females, and athletes who sustain an injury or overuse a joint due to repetitive stress.

Rheumatoid arthritis (RA), on the other hand, is an autoimmune disease, which means that your immune system attacks healthy cells in your body, causing painful swelling of the affected joints.

Because RA causes your body to attack its own healthy tissue, it may cause problems in your heart, lungs, and eyes. While the exact cause of RA is unknown, certain environmental and genetic risk factors have been identified, such as:

• older age
• being female, especially those who have never given birth
• a history of smoking
• obesity
• exposure to environmental toxins

Other forms of inflammatory arthritis that can cause eye issues include:

• reactive arthritis
• psoriatic arthritis
• ankylosing spondylitis

Like joints, your eye’s sclera and cornea also contain collagen, which is what makes up connective tissue. Since arthritis affects collagen, it can lead to problems with your eyes.

These include:

Dry eye

Dry eye refers to any condition that decreases moisture in your eyes. While it can affect anyone, it is often associated with RA.

Dry eye disease can increase your risk for injury and infection because your tear glands protect your eyes.

Another way you can get dry eye from arthritis is from Sjogren’s syndrome. This is an autoimmune condition that can co-occur with arthritis. It can deplete tear production, which can lead to dry eyes.

Learn more about secondary Sjogren’s and arthritis.

Cataracts

You may have cataracts if you experience the following:

• cloudiness in your vision
• difficulty seeing colors
• poor night vision

The condition is more common with older age. But inflammatory forms of arthritis make cataracts a possibility at any age.

In fact, cataracts are commonly seen in people with:

• RA
• psoriatic arthritis
• ankylosing spondylitis
• juvenile idiopathic arthritis (JIA)

Interestingly, some research has shown that other eye diseases can actually increase your risk of cataracts. Factors that impact people with cataracts can also affect the onset of arthritis, including changes in:

• quality of life
• self image
• mobility
• memory
• sleep quality

Surgery in which the natural lenses of your eyes are replaced with artificial lenses is the best treatment for cataracts.

Conjunctivitis

Conjunctivitis, also known as pink eye, refers to inflammation or infection of the conjunctiva lining of your eyelids. It’s a possible symptom of reactive arthritis.

According to the National Institute of Health (NIH), about half of all people with reactive arthritis develop conjunctivitis. Because it results from arthritis, this type of conjunctivitis is autoimmune and is not contagious, unlike pink eye, which is caused by infection.

Glaucoma

Inflammatory forms of arthritis, such as RA, can lead to glaucoma, an eye condition that results in damage to your optic nerves. Arthritis can increase the fluid pressure in your eye, leading to nerve damage.

Early stages of glaucoma have no symptoms, so your doctor needs to check for this disease periodically. Later stages can cause blurry vision and pain.

Scleritis and episcleritis

Scleritis is inflammation of the connective tissue that makes up the protective outer white layer of your eye, known as your sclera. People with scleritis experience eye pain and vision changes.

Episcleritis is inflammation of the episclera, the transparent layer of eye tissue that covers the sclera. This condition causes your eye to look red and irritated, often mistaken for conjunctivitis, but it does not produce discharge.

Scleritis and episcleritis are the most common eye conditions associated with RA. Scleritis is more severe than episcleritis.

Even more severe is necrotizing scleritis, which can cause a hole in the globe of the eye and loss of the eyeball if not treated. Sometimes it is associated with a RA nodule in the sclera.

Because these conditions are associated with RA, you can help decrease your chances of getting these eye problems by managing your arthritis.

Retinal vasculitis

Although rare, retinal vasculitis can be seen in people with RA.

Patients on hydroxychloroquine need to be monitored for retinal side effects. Though it is not common, it is dose and duration dependent.

Vision loss

Vision loss is a possible side effect of certain types of arthritis. Uveitis is often associated with psoriatic arthritis, ankylosing spondylitis, and JIA. Its symptoms include:

• redness
• light sensitivity
• blurred vision

If left untreated, uveitis can result in permanent vision loss.

Diabetes, which seems to share a connection with arthritis, can also lead to eye problems. In fact, diabetes alone can increase your risk of developing glaucoma and cataracts.

In some cases, people taking hydroxychloroquine will need to be monitored for retinal side effects, depending on their dose and treatment duration.

It’s important not to ignore any potential complications of your arthritis. Monitor all symptoms, including potential eye problems. If you have both arthritis and diabetes, it’s even more important to follow your treatment plan and get regular eye exams.

What are signs of arthritis in the eye?

Symptoms of arthritis in the eye can include:

• pain
• dryness
• inflammation
• discoloration
• discharge
• vision changes

These signs could indicate a more serious condition if you have a history of arthritis or diabetes. Speak with your doctor if you have any concerns.

Learn more about the symptoms of arthritis.

How is arthritis in the eye diagnosed?

You will need to see an ophthalmologist, or an eye doctor, that can assess your eyes. They will also ask you for a detailed medical history.

If they are concerned, they may run further tests to determine if you have glaucoma, cataracts, or vision changes.

How is arthritis in the eye treated or managed?

Arthritis in the eye is managed mainly by keeping your arthritis managed to reduce inflammation in your body.

Lubricating eye drops may be helpful if you have dry eyes. You may also need punctal plugs, which are inserted into your tear ducts to keep your tears on the surface of the eye. Otherwise, treatment is specific to the condition you have with your eyes, such as infection or cataracts.

Learn more about punctal plugs.