Eye Problems Associated With Immunological Disorders

Patients with systemic diseases and conditions frequently will also have ocular manifestations of those disorders. Recognizing these findings is vital to proper treatment.

Patients who come to our office with complaints of dry eyes, or inflammatory conditions like Iritis, Uveitis, Scleritis or Episcleritis frequently are also suffering form immunological conditions as well. While we can usually treat the ocular conditions effectively, the individual must seek medical treatment from his/her general practitioner for the underlying disorder.

Rheumatoid Arthritis is an autoimmune condition resulting in inflammation. The Rheumatoid factor attacks the immunoglobuli
G (IgG), resulting in the release of inflammatory cytokines from white blood cells causing edema and cell death. The joints are particularly at risk for damage. In the eye, the basement membranes break down; thereby permitting the destruction of the underlying ocular tissue. At first, this occurs at the tear producing gland (lacrimal gland) causing a decrease in tear production, and then dry eye. Episcleritis, the inflammation of the outer most layer of the eye wall, is a common result as well. These conditions are frequently treated with either topical steroids, and/or NSAIDs very effectively. A more serious condition is Uveitis which is an internal inflammation. This may result in permanent damage to the eye. In severe cases Anti-rheumatoid medicines such as Plaquenil must be employed.

HLA-B27 disorders are a group of diseases that present with similar ocular findings. The conditions include Ankylosing Spondylitis, Psoriatic Arthritis, Arthritis, and Behcet’s Disease; there are other connective tissue disorders as well. The most common ocular finding with these disorders is nongranulomatous Uveitis, and Iritis. Treatment includes pupillary dilation, and topical steroids like Pred Forte. Recurrence frequently occurs, and rapid aggressive treatment is needed to prevent chronic inflammation and ocular damage.

Acne Rosacea presents with pustules, papules, and telangiectasia (small blood vessels in the skin). Ocular findings include chronic blepharitis (lid inflammations), conjunctivitis, meibomian gland break down, corneal thinning and then perforation. Treatment begins with artificial tears and warm compresses, and increases to antibiotic eye drops and steroids drops if needed. Doxycycline, an oral antibiotic has been found to be very affective in curing the blepharitis component of the disorder.

Giant Cell Arteritis is an inflammation of the giant cell arteries in the cranial cavity, and requires emergency treatment. Rapid treatment is required, or the condition can be fatal. The eye doctor may notice changes in the Optic nerve. This patient needs to be hospitalized as soon as possible.

Inflammatory Bowel Disease (IBD) such as Crohn’s, Ulcerative Colitis and Proctitis, are inflammations in the intestinal walls. Ocular manifestations may include Episcleritis and Uveitis. Unlike with the other conditions discussed, IBD may results in Posterior Uveitis which is more serious, and may result in greater ocular damage. Treatment then may require systemic immunosuppressant and injections directly in the eye. This treatment may lead to Cataracts, Glaucoma and Cystoid Macular Edema. Treatment must therefore be carefully monitored.

With immunological disorders the key to proper treatment is rapid, accurate diagnosis. If left untreated, many of these ocular findings can severely damage the eye and reduce vision.