My BasketThe Link Between Rheumatoid Arthritis And Dry Eye
Although many people think of painful and swollen joints when they think of rheumatoid arthritis, this form of inflammatory arthritis also causes various complications in different parts of the body, including the connective tissues, skin, muscles, and even the eyes - with having dry eyes being the most prevalent eye complication associated with rheumatoid arthritis.[1] In fact, up to 44% of people living with rheumatoid arthritis will experience eye dryness at some point,[2] being characterised by scratchy, sore, stinging, and light-sensitive sensations.
When dry eye is chronic and ongoing, it has the potential to damage your cornea on the outside of the eye, leading to vision loss over time. This is why it’s crucial for those with rheumatoid arthritis to complete comprehensive eye exams at least once a year, as early detection and treatment can significantly protect vision.
What Happens When We Have Dry Eyes?
Whenever you blink, in normal circumstances, a thin tear (called a tear film) spreads across the surface of the eye. This helps keep our eyes nourished, hydrated and lubricated while cleaning away anything that gets in the eye. So anything that interferes with this tear film in any of its three layers (oil, water and mucous) can result in eye dryness. We often see dry eyes developing from a person not producing enough tears as part of the tear film, or having a clogged gland that results in not enough oil being added to the tear film, so the tears evaporate faster than normal and don’t nourish and lubricate the eyes in the way they should.
What Happens To The Eye In Rheumatoid Arthritis?
In rheumatoid arthritis, the body’s own immune system mistakenly attacks healthy tissue in the body such as the connective tissues within joints, causing swelling, pain and inflammation. Given that the connective tissues contain collagen, the body sometimes attacks other collagen-containing tissues, like the ones in our eyes such as the whites of the eye (sclera) as well as the cornea. This is why those with rheumatoid arthritis are more likely to experience eye conditions such as:
Keratitis
The cornea, which is the clear outer layer covering the front of the eye, can become inflamed, a condition known as keratitis. If left untreated, keratitis can cause pain, redness, and sensitivity to light, and in severe cases, it may result in scarring or vision loss. It is crucial to seek prompt treatment for keratitis to prevent further damage to the eye.
Uveitis
Uveitis is the inflammation of the middle layer of the eye, which can cause redness, blurred vision, sensitivity to light, and the sudden appearance of floaters or small spotty dark objects in a person's vision. It is essential to seek immediate treatment for uveitis to prevent potential complications.
Dry eyes
When a person has rheumatoid arthritis, the antibodies produced by their immune system may attach to the components of the eyes that generate tears. This can lead to a variety of dry eye symptoms, including redness, burning, itching, grittiness, pain, and blurred vision. It may also feel as though something is stuck in your eye, and your eyes may become excessively watery in an attempt to compensate for the dryness. Wearing contact lenses can be uncomfortable, and stringy mucus may accumulate around the eyes. In addition, dry eyes are more prone to infections.
Scleritis
Inflammation of the sclera, or the white part of the eyes, is referred to as scleritis. Rheumatoid arthritis is responsible for up to 15% of all cases of scleritis,[3] which can cause pain, redness, sensitivity to light, and in severe cases, vision loss if left untreated. It is imperative to seek prompt treatment for scleritis associated with rheumatoid arthritis to avoid potential vision problems.
Sjögren's Syndrome
10-30% of all individuals with rheumatoid arthritis also have Sjögren’s syndrome, another autoimmune condition that affects the glands in the body responsible for producing moisture, including the mouth, skin, joints and eyes, meaning they are less lubricated and become dry and painful. For people with both rheumatoid arthritis and Sjögren’s syndrome, dry eyes can be particularly common and bothersome, and you may have difficulties elsewhere too, including a dry mouth, difficulty swallowing, and cracked skin.
Home Treatment For Rheumatoid-Arthritis Related Dry Eyes
As ongoing eye dryness can result in corneal damage and vision loss over time - as well as much discomfort to your daily comfort and quality of life - we always recommend annual eye exams if you have osteoarthritis so effective treatment can be administered early, and any degenerative changes can be detected early too. If you’re dealing with dry eyes at home, you can try:
Using warm compresses over the eyes
Warm compresses are proven to help your eyes to produce more tears as well as unclog blocked glands, releasing moisturising oils back into your eyelid.[4],[5] They are very effective, with studies showing an 80% increase in the thickness of the oily layer over the eye in just five minutes, and an additional 20% increase after 15 minutes.[6]
Reducing daily screen time on both large and small devices
People who use computers for extended periods of time have been found to have a much higher rate of dry eyes[7] and other troublesome visual symptoms, such as eye strain, headaches and blurred vision.[8] If you work at the computer or stare at digital devices like smartphones or televisions for long periods of time, you may be blinking as little as only 7 times per minute compared to the standard 22 times per minute.[9] Try using the 20/20 rule - every 20 minutes, close your eyes for 20 seconds.
Eat more Omega-3s through whole foods or supplements
Research has confirmed that taking omega-3 fatty acid supplements may significantly improve the uncomfortable symptoms of dry eyes,[10] by helping to stimulate more tears, and to increase the eye’s production of oil from the meibomian glands, which lubricates your eyes and prevents the natural tears from evaporating. Omega-3 fatty acids are naturally found in fish such as salmon, herring, sardines, squid, scallops and mussels. Plant-sourced omega-3s are found in walnuts, linseed/flaxseed, chia seeds and oils such as canola and soybean
Taking extra steps to protect your eyes
Dry air, wind, dust, sunlight and air conditioning can contribute significantly to the symptoms of dry eyes, so managing these factors to the best of our ability may help reduce and prevent eye dryness. If the air is particularly dry like in the winter months, consider using a humidifier to improve the air moisture at home, and avoid sitting near air conditioners and fans if you can. Keep your eyes closed when using hair dryers, and wear protective wraparound sunglasses when it’s sunny or windy outside to protect your eyes against UV exposure damage and decrease the chance of dust or debris entering your eye.
Seeing Your Optometrist
While mild and temporary dry eye cases can be eased by using home remedies, those with rheumatoid arthritis are highly recommended to have an annual eye examination with a qualified optometrist to manage their eye health, identify other associated conditions like uveitis and keratitis, and monitor any changes that may occur over time. Chronic dry eye can result in complications like corneal scarring and vision loss, which highlights the importance of seeking prompt and regular eye care from experienced optometrists to evaluate your eye health and begin appropriate treatment as needed.
Dry eyes can also be triggered or aggravated by various factors, including ageing, hormonal changes, and certain medications such as some antihistamines, antidepressants, and blood pressure medications. At Stacey & Stacey Queensland clinics, our friendly optometrists adopt a holistic approach to eye health, and each treatment plan is tailored to meet your individual needs, preferences, and enhance your quality of life. Our optometrists can also refer patients to an ophthalmologist, or an eye surgeon, for advanced treatment if required.
We are here to optimise your eye health across all stages of your life. If you have rheumatoid arthritis and have concerns about your eye health or are noticing changes, contact one of our friendly clinics here.
[1] https://www.aao.org/eyenet/article/ocular-involvement-in-rheumatoid-arthritis
[2] https://iovs.arvojournals.org/article.aspx?articleid=2334381
[3] https://pubmed.ncbi.nlm.nih.gov/34068884/
[4] https://pubmed.ncbi.nlm.nih.gov/12695712/
[5] https://pubmed.ncbi.nlm.nih.gov/24270634/
[6] https://pubmed.ncbi.nlm.nih.gov/12695712/
[7] https://pubmed.ncbi.nlm.nih.gov/18708259/
[8] https://pubmed.ncbi.nlm.nih.gov/21480937/
[9] https://pubmed.ncbi.nlm.nih.gov/8426634/
[10] https://pubmed.ncbi.nlm.nih.gov/30702470/