How Autoimmune Conditions May Affect Your Eyes
Chronic inflammation can be linked to vision problems
En español | People with autoimmune disorders — including several types of arthritis, inflammatory bowel disease (IBD), lupus and multiple sclerosis (MS) — can also develop swelling and inflammation in the middle section of the eyes that can destroy eye tissue.
Sometimes this results in an uncommon but serious eye disease called uveitis, which can cause significant vision loss, says Alan G. Palestine, M.D., professor of ophthalmology and rheumatology at the University of Colorado School of Medicine and chief of the Uveitis and Ocular Immunology Division at the Sue Anschutz-Rodgers Eye Center. “It is best diagnosed and treated by a complete eye exam, with testing performed by an ophthalmologist, and long-term management is often needed.”
Uveitis symptoms may include pain and redness in the eye, blurred vision, light sensitivity, decreased vision and floaters in your field of vision. You can get it in one or both eyes, though some studies have shown you are more likely to get it in both eyes if caused by an autoimmune disease. While symptoms can develop gradually, they may also come on suddenly and quickly get worse.
The good news is that there's no connection between uveitis and osteoarthritis, the most common form of arthritis, according to H. Nida Sen, M.D., director of the Uveitis and Ocular Immunology Fellowship Program at the National Institutes of Health's National Eye Institute, and a clinical professor of ophthalmology at George Washington University. Osteoarthritis, which affects about 32.5 million American adults, causes joints to break down from wear and tear, and is largely associated with advanced age.
How inflammation affects the eyes
The types of arthritis that can cause vision problems are usually associated with an autoimmune disease, in which an overactive immune system attacks various parts of the body, including organs and joints, and causes inflammation. They include rheumatoid arthritis (RA); psoriatic arthritis, which can accompany the skin condition psoriasis; and reactive arthritis, an uncommon and often temporary condition triggered by an infection.
In addition to IBD, lupus and MS, other autoimmune diseases that may lead to uveitis are ankylosing spondylitis, sarcoidosis and Behcet's disease, according to James T. Rosenbaum, M.D., an ophthalmology professor at Oregon Health & Science University School of Medicine who specializes in inflammation research.
IBD, which includes ulcerative colitis and the more severe but less common Crohn's disease, affects the gastrointestinal tract; lupus can affect multiple organs as well as joints; MS can damage the nerve fibers in the brain, spine and eyes; ankylosing spondylitis attacks the spine; Behcet's disease inflames the blood vessels; and sarcoidosis inflames the lungs and can affect other organs as well as joints.
"In an older age group, shingles and sarcoidosis become important causes of uveitis,” Rosenbaum adds.
While autoimmune diseases can run in families, not everyone whose parents had one will get one themselves. These diseases may be triggered by a wide variety of environmental factors that can include an infection you may have picked up at some point in your life, your socioeconomic status, and whether you smoke cigarettes or drink alcohol. These environmental factors can even stretch far back into your childhood, to your birth weight or whether you were breastfed as an infant.
Although there is no direct connection between uveitis and autoimmune diseases that attack the thyroid, such as Hashimoto's thyroiditis and Graves’ disease, patients with any autoimmune disease are more prone to getting other autoimmune diseases, some of which may affect the eyes.
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Graves’ disease can cause what is called thyroid eye disease (TED), which mainly affects the muscles and tissue directly outside of the eyeball and can lead to bulging and dry eyes, according to Sen. And other autoimmune diseases can cause eye conditions with a variety of symptoms, including corneal ulcers and scarring. If you have Hashimoto's thyroiditis, Graves’ disease or another autoimmune condition, and you have concerns about your eyes, talk to your doctor.
People who do not have an autoimmune disease can also get uveitis from an infection.
Many cases of uveitis are mild and can be managed with eye drops, according to Rosenbaum. “A rheumatologist can have a vital role if a systemic disease is suspected in association with the eye inflammation,” he says. “And some patients with uveitis have a potentially blinding disease that requires immunosuppressive medications similar to the approach to rheumatoid arthritis.”
He adds that rheumatologists are likely more comfortable than ophthalmologists in prescribing these types of medications, also known as immunosuppressants, which may include methotrexate, prednisone or adalimumab (Humira). These medications suppress an overly aggressive immune system, effectively telling it to back off and stop attacking your body's healthy tissue, including the tissue in your eyes.
Since the immune system exists in glands and other areas throughout the body, if you have an autoimmune disease that is affecting your eyes, you'll need a systemic treatment such as a pill rather than eye drops, which would treat only the eyes. If the underlying disease is well controlled with immunosuppressant medications, according to Sen, this makes the odds better for preserving your vision as well.
Patients are usually kept on immunosuppressant medicines for a sustained period of time, sometimes as long as a year, before tapering off. Sometimes the uveitis will reoccur, and you may need to be treated again.
The takeaway: If you have an autoimmune disease that's known to have a strong association with causing inflammation in the eyes, or if you take medications that have known side effects that affect the eyes, be sure to see an ophthalmologist for frequent monitoring.