Most patients with eye inflammation do not have any symptoms. Untreated eye inflammation (uveitis) can lead to scarring of the eye, glaucoma (increased eye pressure), cataracts and blindness. That is why your eyes need to be checked regularly by an ophthalmologist or optometrist. If you have no active eye inflammation, you should still have regular eye check-ups.
Regular eye exams
Patients can develop eye inflammation when their joints are in remission. Therefore, even if your joints are quiet, and you don’t need to see their rheumatologist as often, you still need to keep up with your eye-screening visits.
Your rheumatologist will tell them how often your eyes need to be examined. This will depend on a couple of things. There are certain things that may put them at higher risk—or make it more likely that they will develop uveitis:
• If your arthritis was diagnosed before age seven
• If you have a blood test that shows a positive anti-nuclear antibody (ANA).
If either of these applies to you, you will need to be seen more often for the first five years after your diagnosis of JIA.
Also, during the eye exam, your eye doctor may put special drops in your eye to temporarily make your pupil larger. This helps the eye doctor to get a better look at the inside of the eye. About 30 to 40 minutes later, the drugs will take effect. You will have large pupils, blurred vision (especially for things that are up close) and maybe some sensitivity to bright light. It may be helpful to bring along a pair of sunglasses for the ride home.
Also, during the exam, the eye doctor will perform a slit lamp examination. This is a painless test. The eye doctor uses a special, high-powered microscope to look into the eye for any signs of inflammation. You simply put your chin on a special rest while the doctor looks at your eyes.
The frequency of your eye exams will depend on your risk of developing eye problems. Your eye doctor and rheumatologist will decide how frequently you should have your eyes checked.
To help manage any eye inflammation (iritis/uveitis) you may develop, your doctor might prescribe eye drops, such as steroids or pupil dilators. It is important to ask why you need the eye drops. Also find out if they will cause any temporary blurred vision.
Below are some quick tips to remember about eye drops:
• Do not use eye drops that have changed colour or appear to have crystals. Some steroid eye drops are meant to be milky white. These are OK to use. If you are unsure, ask your eye doctor or rheumatologist.
• Do not use eye drops if they have passed the expiry date.
• Make sure the tip of the bottle does not touch your eyes, fingers, or any other surfaces.
• If you are using more than one type of drop, wait 20 to 30 seconds between each kind of drop if possible. This is sometimes difficult and not absolutely essential.
• Be sure to shake steroid eye drops well (30 times) before using.
Systemic medications for eye disease
Sometimes eye drops are not enough to control your eye inflammation. Your doctor may prescribe oral steroids or other medicines such as methotrexate, infliximab or entaneracept. These drugs may be given by mouth or injection to help control the eye inflammation. Medicine for glaucoma treatment can sometimes also be given by mouth.