Red Eye – Not Always An Overnight Flight
Complications of rheumatoid arthritis extend beyond the joints. RA can affect the lungs, blood vessels, eyes, bones, and more. Fortunately my RA has been centered around my joints with very little bone erosion. My organs are healthy and I’m doing really well. But recently RA has affected my eyes.
Approximately 25 percent of people living with RA will experience acute, chronic, or recurrent eye problems. Inflammation can attack the eyes and lead to dry eye syndrome (keratoconjunctivitis sicca), scleritis, episcleritis, keratitis (inflammation of the cornea), and uveitis. Certain medications commonly used in RA can also contribute to the development of glaucoma, cataracts, retinal damage, and macular edema.
Last Wednesday when I woke up, part of my left eye was quite red. At first I suspected an eye infection, perhaps viral conjunctivitis, or severe allergies. My eyeball felt sore and the pressure of my eyelid closing over the red part was painful. I kept checking the redness throughout the day to see if it got worse, stayed the same, or got better. If it were an eye infection, I expected it to get much worse.
The next morning, the redness had spread somewhat, the pain was the same, but there seemed to be no evidence of infection since there wasn’t any goopy discharge. So my suspicions turned to something inflammatory. I called the eye doctor and was able to get an appointment just before the holiday weekend. He confirmed that I did not have an infection. After a thorough exam, I was diagnosed with episcleritis. During the course of the visit, I learned some important things about scleritis and episcleritis which affect less than 10 percent of RA patients. Dry eyes are much more common.
The sclera is the white part of the eye and the episclera is the thin membrane between the sclera and the cornea. Although symptoms of scleritis and episcleritis are similar, there are important differences. Inflammation causes redness in both conditions, but the pain of scleritis is much more severe and complications can be very serious. My doctor used the type of eyes drops that dilate pupils. This solution constricts blood vessels which can reduce redness in episcleritis but not scleritis.
Episcleritis, a more common and benign cause of redness of the eye, has two forms: nodular and simple. Simple episcleritis can be diffuse (affecting the entire white portion of the eye) or sectoral (affecting a segment of the eye). Nodular episcleritis has obvious lumps of inflamed tissue. Both forms of episcleritis might be confused with severe conjunctivitis (eye infection) because of the bright-red, bloodshot appearance of the eye.
My case of sudden eye redness and mild pain was caused by sectoral episcleritis. Initial treatment is focused on relieving discomfort. My doctor prescribed very strong corticosteroid eye drops to be used several times each day until the redness is gone, followed by a gradual tapering of the dose over several days. I’ve been told that this flare-up may last for 7-10 days during which time I really can’t wear my contacts because of the eye drops. I’m on day four of treatment and haven’t seen much change yet. (Update: Day 16 and the redness is finally noticeably reduced; not gone yet, but less prominent.) Since episcleritis can be a recurring condition with episodes every few months, I will be prepared to take quick action if it does come back.
If you notice sudden changes in your vision or the appearance of your eyes, please call your eye doctor immediately. It may be something simple and benign, or something much more serious. Careful examination is needed so that you can receive the appropriate treatment.