top of page

Rheumatology

  • Rheumatological diseases which may cause eye disease:

    • Rheumatoid arthritis

      • Inflammation in sclera – scleritis

    • Seronegative arthritides – HLA-B27 positive

      • Ankylosing spondylitis, Reiter’s disease

      •  anterior uveitis

    • Sjögren’s syndrome

      • Dryness of cornea

    • Juvenile idiopathic arthritis

      • Anterior uveitis in children

    • Behcet’s disease

      • Devastating panuveitis

    • Sarcoidosis

      • Intraocular inflammation

    • SLE

    • Granulomatosis with polyangiitis

    • Giant cell arteritis

  • Some features that may present:

    • Dry eyes

      • RA, (can cause secondary Sjögren’s)

    • Episcleritis

      • Mainly rheumatoid arthritis

      • Image to right shows localised area of superficial redness

      • Not particularly painful, may have some discomfort

      • Segmentally red rather than entire sclera; may just be nasal or temporal aspect

      • Managed with lubricants or short course of anti-inflammatory medication

    • Uveitis

      • Behcet’s, sarcoidosis, JIA

    • Retinal vascular occlusion

      • SLE

    • Orbital disease/ inflammation

      • Granulomatosis with polyangiitis

    • Anterior ischaemic optic neuropathy (can also present with CRAO)

      • GCA

​

Ankylosing spondylitis

  • Classical patient with ankylosing spondylitis in image to right – disease of lower back

  • Typical x-rays on right hand side

  • Associated with recurrent bilateral sequential anterior uveitis; tends to affect one eye then second eye etc.

  • Detected by ophthalmologist with slit lamp by microscopy

    • Image to right shows front of eye

      • Irregular pupil = posterior synechiae

      • Usually clear aqueous in anterior chamber is replaced by inflammatory exudate which is sticky; adhesions form between iris and anterior lens capsule

      • As iris is stuck down, it is unable to fully dilate; patient has probably had dilating eye drops; where eye has tried to dilate, superiorly the links between the iris and anterior lens capsule have broken; iris is trying to pull away. Lump of pigment where iris was previously stuck to lens

      • Can cause visual symptoms, degree of eye strain as in discomfort as eye tries to dilate

      • Break links with topical cycloplegic such as cyclopentolate (to dilate eye)

 

Behcet’s disease

  • Idiopathic multisystem disorder

  • Occlusive vasculitis – eyes involved in 75%

  • Presents in the 3rd and 4th decades

  • Diagnosis: oral ulceration with two of:

    • Recurrent genital ulceration

    • Skin lesions – folliculitis, erythema nodosum

    • Positive pathergy test

    • Eye involvement

      • Acute anterior uveitis

      • Vitritis, vasculitis, retinitis

  • Treatment, systemic immunosuppression

  • Devastating, potentially blinding condition of young adult

  • Not common in UK, tends to affect countries in old silk route – China, to Mediterranean

  • Some of the features:

    • Hypopyon in uveitis

    • Retinal vasculitis on dilated examination

      • Areas of sheathing of blood vessels (fundus fluorescein angiogram in bottom right – inject with dye, take images with special filter on lens)

  • Other systemic tests

    • Oral ulcers

    • Genital ulcer

    • Positive pathergy test – pustule reaction following breaking of skin with needle

​

Giant cell arteritis

  • Risk of blindness from anterior ischaemic optic neuropathy

  • Risk of systemic involvement including cerebrovascular accident – strokes or MIs

  • Often preceding history of amaurosis

    • Temporal headaches, jaw claudication, weight loss, night sweats, transient visual obscurations

    • Associated with polymyalgia rheumatica

    • Will affect other eye in 70% if not diagnosed and treatment

​

bottom of page