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Posted on 08-09-2016

Of course there are many and various reasons to have your eyes examined annually by an optometrist or ophthalmologist, but this is particularly important if you have been diagnosed with an autoimmune disease.  The more common – and not so common – ones are as follows: Rheumatoid arthritis * Juvenile rheumatoid arthritis (approximately 80% of cases of rheumatoid 
arthritis in children) * Sjogren’s syndrome * Behcet disease * Ankylosing spondylitis * Reiter’s syndrome * Psoriatic arthritis * Systemic lupus erythematosus * Multiple sclerosis * Giant cell arteritis * Graves’ disease * Myasthenia gravis * Sarcoidosis.
 
Suppose you have never been diagnosed with any of the above?  Good!  However, be educated and understand that the above diseases – and many others – are often diagnosed or detected first during an eye exam.
 
The eye may be affected as a target of an inflammatory attack as a result of any of these autoimmune diseases.  The eye may, however, in some instances, be the specific and only target affected by certain autoimmune diseases.
 
For patients who are taking systemic medication for an autoimmune disease – like corticosteroids or Plaquenil – annual eye exams are imperative to monitor for toxicity or adverse ocular manifestation (not the least of which is the development of cataracts).  Don’t wait for blurred vision and/or discomfort to bring you in to see an eye doctor.
 
What do these diseases have in common and what does the optometrist or ophthalmologist look for… and then what?
 
The common thread with these diseases is inflammation.  In addition to a thorough medical history and being alert for suspicion of any of these autoimmune diseases, the doctor may look for keratoconjunctivitis sicca (dry eye affecting the health of the cornea), scleritis (inflammation of the sclera), epi-scleritis (inflammation of the epi-scleral blood vessels), ulcerative keratitis (corneal ulcers), choroiditis (inflammation of the choroid), retinal vasculitis (inflammation of the retinal vasculature), retinal detachments-tears-holes-other retinal anomalies, macular edema (swelling of the macular region of the retina), uveitis (inflammation of the uveal tract – made up of the iris, ciliary body, and choroid), conjunctivitis (inflammation of the conjunctiva), retinal hemorrhages, proliferative retinopathy, optic neuritis (inflammation of the optic nerve), ischemic optic neuropathy, hemianopia (visual field defects), amaurosis fugax, pupillary abnormalities, oculomotor abnormalities (eye movement skills and coordination), band keratopathy (calcium deposits in the anterior cornea), hypopyon (white blood cells in the anterior chamber), keratic precipitates (an accumulation of inflammatory material on the posterior surface of the cornea), and more.
 
To help with the location of these structures, see diagram below:​

​Just as there are many ocular structures that can be affected by either ocular or systemic manifestations of autoimmune diseases, there are many and varied approaches to treatment from topical prescription eye drops to oral medications to chemotherapy to surgical intervention; or some combination of these. Additionally, it may be appropriate / helpful in some circumstances to use good quality UV absorbing sunglasses, a room humidifier, artificial tears/ocular lubricants.. even IV steroids in severe cases of optic neuritis. 
    
Just as the family physician may refer a patient with suspected ocular manifestations from an autoimmune disease to an optometrist or ophthalmologist, in more severe or unresponsive cases, the optometrist or ophthalmologist may ultimately refer the same patient on to a corneal specialist, retinal specialist, neuro-ophthalmologist, chemotherapist or some other tertiary care specialist for additional consult or care.
 
I recently read an article written by C. Stephen Foster, M.D., FACS, FACR, Founder and President, Ocular Immunology and Uveitis Foundation, in which he wrote (I am paraphrasing): Ophthalmologists and optometrists in general are not accustomed to treating patients systemically, and in particular, are not trained to use immunosuppressive drugs in order to control autoimmune phenomena.  Many ophthalmologists and optometrists, however, realize that such treatment is appropriate and indicated for the aforementioned problems, and therefore, the ophthalmologist and optometrist will collaborate with the chemotherapist who will take responsibility for monitoring and managing the patient’s system therapy (when appropriate), while the ophthalmologist or optometrist monitors the progress of the ocular manifestation of the autoimmune attack (inflammation).
 
The next time your eye doctor asks you to fill out a complete medical history intake form, or wants to dilate your eyes, you might give some thought as to why; better still… just ask.  Eye doctors really do a bit more than say, “Which is better one or two” (see blog article, Eye Exams: Do Optometrist Just Say “One or Two” All day? – 03/01/15).
 
As usual, I am interested in your comments.  Please write to me at Info@drcharm.com.
​I continue to enjoy hearing from you and answering your questions.  It's a pleasure to learn together.

Be well,
Dr. Charm

Anaheim Hills Family Optometry
​6200 E. Canyon Rim Rd., Suite 101
Anaheim Hills, CA 92807
(714) 998-2020

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