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The Link Between Rheumatoid Arthritis & Dry Eye

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Many of us rub our eyes when we’re tired, and you might know firsthand how itchy and uncomfortable that can be. But some people have that sensation all the time. Itchy eyes, blurry vision, mucus buildup or sensitivity to light are some unpleasant symptoms of dry eye.

Dry eye is something we see in our patients sometimes, and it’s not something that just goes away. Dry eye can have a variety of causes, from environmental factors to autoimmune disorders like rheumatoid arthritis. Fortunately, you can get treatment for dry eye, but you need to know whether it’s the result of an autoimmune imbalance. Not all dry eye has the same cause.

What Is Dry Eye?

Dry eye patients usually suffer from similar symptoms, but it’s a condition that can have several causes. Your eye’s tear film is a mixture of water, oil, and mucus. If the balance in the mixture is off, or if it distributes unevenly over the surface of the eye — dry eye is the result.

The causes can vary quite a bit and several types of dry eye exist. Evaporative dry eye is the more common type. It lacks a key feature found in dry eye due to autoimmune issues: autoantibodies.

Autoantibodies

Your body produces defensive immune system proteins, called antibodies. They bind to cells and attempt to destroy them. Autoantibodies are harmful antibodies that come with certain disorders, and they’re called that name because they attack friendly cells. 

Dry Eye & Autoimmune Disorders

Evaporative dry eye patients often have some dysfunction in the gland that produces the oil layer (also called the lipid, or fatty acid layer). But dry eye can have other causes.

Having an autoimmune disorder means your body regularly attacks its own cells, often making general health problems chronic and severe. Autoimmune disorders are not uncommon, and unfortunately, they don’t have a well-defined set of causes.

Sometimes autoimmune disorders are inherited from your parents. In contrast, others need some kind of bacterial or viral infection to activate. In our optometry patients, we sometimes recognize dry eye as a consequence of immune disorders.

Grave’s Disease

Dry eye from Grave’s disease is the result of a few intermediate steps. Grave’s disease is an immune disorder where your antibodies attack the thyroid gland, which responds by overproducing hormones.

The hormone imbalance can affect the muscles and tissues around the eyes. About 30% of people with Grave’s disease get what’s called ophthalmopathy

The effects of ophthalmopathy can be painful in their own right. Eyelid muscles may twitch or coordinate improperly, and buildup of tissue behind the eyes can result in their bulging. In these cases, patients may end up with dry eye due to the inability to blink their eyes completely closed. Their blinking will not be able to keep their tear film from evaporating.

Hashimoto’s Thyroiditis

This immune disorder has a lot in common with Grave’s disease, but the way that cells attack the thyroid results in the underproduction of hormones. It doesn’t have quite the same effects on the eyes. In a portion of Hashimoto’s disease patients, the eyes can suffer symptoms similar to Grave’s disease. In these cases, dry eye may be a result.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is another immune disorder, often found hand-in-hand with Sjogren’s syndrome. It’s not a usual case of arthritis, known more formally as osteoarthritis. In the case of the rheumatoid kind, autoantibodies attack cartilage cells in the joints, mistakenly flagging them as foreign microbes.

But the autoantibodies also turn on other cells in the body, not just cartilage. They also attack the skin, lungs, heart, kidneys, salivary glands, nerve tissues, bone marrow, blood vessels, and notably the eyes.

Sjogren’s Syndrome

One notable autoimmune-based cause of dry eye is Sjogren’s syndrome. This condition can often go hand-in-hand with other immune system disorders, like rheumatoid arthritis and lupus. The moisture glands in your eyes and mouth cease to function normally, so your tears don’t get as much water content. This problem leads to dry eye symptoms.

How Rheumatoid Arthritis Leads to Dry Eye

Silver pen and green and blue paper questionnaire for sjogren's syndrome asking if you're at risk

Because rheumatoid arthritis patients so often have Sjogren’s syndrome or Grave’s disease at the same time, the tear composition might end up being affected almost as much as the joints. The tear ducts provide the tear film’s watery layer, and these glands often suffer the same fate as the salivary glands: underproduction.

If there isn’t enough water in your tears, dry eye might be the result. With untreated dry eye, you might experience the downsides of a deficient tear film. That can include:

In the case of rheumatoid arthritis and its interdependence with Sjogren’s syndrome, dry eye symptoms might arise from the battle between the immune system’s antibodies and the tear production gland, also known as the lacrimal gland.

Inflammation & Dry Eye

Because of the lack of basal tears, in other words, the level of tears that you need to keep your eyes from drying out — you might experience inflammation. Inflammation is probably the least of your worries in this case.

Your eyes might feel itchy, puffy, and they’re red in colour as they dry out with the air. If the inflammation goes insufficiently treated, it could lead to tissue damage on your eyes’ outer surface.

Treatment & Management for Dry Eye & Rheumatoid Arthritis

Some very basic things that can help are simple habits:

  • Don’t smoke.
  • Avoid sitting next to air conditioners and heaters.
  • Use a humidifier in your bedroom at night.
  • Take frequent screen breaks.
  • Blink often.
  • Eat more fish, or ask your doctor about taking fish oil pills. Omega-3 fatty acids in salmon, tuna, and sardines help block inflammation and may make your eyes feel better.

Medication

But these habits are just a starting point. To combat the inflammation part of suffering from autoimmune-based dry eye, you might need some medicine.

A good bet is eye drops, which can help each affected area. Eye drops might be the over-the-counter variety, but you can get prescription eye drops with special active ingredients. Some eye drops have immune-suppressing medication.

Your optometrist might recommend targeting the inside of your eyelid if the distribution of your tears happens to be uneven. For eyelid inflammation, you can get soft inserts which dissolve slowly and prevent evaporation. Antibiotics can work on the eyelids too

Contact Lenses

Contact lenses can provide some relief, preserving moisture, so you don’t have to rely on natural production as much. There are specialty contact lenses called scleral contact lenses that keep a reservoir to hydrate the eyes with a deficient tear film. You can also switch to silicone-based soft contacts, or rigid gas-permeable lenses if your optometrist recommends them!

Get Treatment for Dry Eye Regardless of its Cause

Whether your dry eye symptoms have a fundamental cause — or they’re a distant consequence of an autoimmune disorder like rheumatoid arthritis and Sjogren’s syndrome — you’ll need to get treatment as best you can. Optometrists who provide care for eye diseases can save you a lot of the headache that comes with it. Contact us, if you have an autoimmune disorder and you’re looking at eyecare options. Living as comfortably as you can is within your reach.

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  • Written by Stephen Lobaugh

    Dr. Lobaugh earned his doctorate from the New England College of Optometry in 1997 and has dedicated his career to providing high-quality eye care services to residents of the Washington-Baltimore area.

    Dr. Lobaugh is an Affiliate Doctor with TLC Laser Eye Centers, a position that allows him to effectively co-manage a variety of refractive surgeries including LASIK, PRK, and KAMRA inlay. He is also certified by the International Association of Board of Examiners in the treatment and management of ocular disease.

    In 2015, Dr. Lobaugh joined the Eye Rx team, allowing us to open our second location in Washington. He hopes to continue to serve the residents of the D.C. Metropolitan area for many more years to come.

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