Eye Problems and Juvenile Idiopathic Arthritis

Uveitis in JIA

Uveitis is an inflammation inside the eye that can reduce vision. Uveitis happens with only some forms of JIA. It is more common in people with oligoarticular arthritis. It does not matter how severe the JIA is. In fact, uveitis is most common in young people with only one or two joints affected. Uveitis may even start before JIA is diagnosed.

Uveitis is not related to how active JIA is. The joints can be inflammed and painful while the eyes are fine. It is also possible to have severe eye disease while the joint disease is in remission.

Uveitis can start in one eye and never involve the other eye, or it can start in one eye and later involve the other eye. Sometimes, it can start in both eyes at the same time. However, if your child has had uveitis in only one eye for six to 12 months, they are unlikely to get it in the other eye.

Anatomy of the Eye
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The most common form of uveitis in JIA is known as iridocyclitis or iritis. It affects only the front part of the eye where the coloured part around the pupil, called the iris, is located. Iritis often occurs without symptoms and with no visible signs. You may not be aware that your child has it. Therefore, it is important to have your child's eyes checked regularly, even if they are not red or painful. Iritis is treated with corticosteroid eye drops or other medications, including pills, injections, or intravenous medications. This medication protects the eyes and will help prevent blindness.

JIA can sometimes cause uveitis in other parts of the eye. These other types of inflammation are less common but more severe in terms of decreasing your child's vision.

In the early stages, uveitis can only be seen on a special eye exam, which must be done by an ophthalmologist or optometrist. An ophthalmologist is a medical doctor specially trained in eye care and treatment. An optometrist is a health-care professional who can diagnose eye problems. Your child should have regular eye check-ups by an opthalmologist or optometrist to make sure that their eyes are healthy.

Cataracts in JIA

When the lens of the eye becomes cloudy, it is called a cataract. Cataracts can affect one or both eyes. Cataracts in young people are rare, but they can occur with JIA. The cloudy lens prevents the rays of light from focusing normally on the retina, which is the lining of the back of the eye. The vision becomes blurry when you have a cataract. Depending on how much and which part of the lens is cloudy, your child's vision may be mildly or seriously affected.

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A normal clear lens focuses the image on the retina. A lens clouded by a cataract results in a blurry image.

Cataracts can also occur as a side effect of certain medications used to treat JIA, such as corticosteroids. These side effects may depend in part on the amount and length of time over which the corticosteroid is used. Some young people seem more sensitive to this than others for reasons we don’t really understand. Even though the corticosteroid eye drops used to treat iritis can cause a cataract, the risk of getting a cataract from iritis is higher if these eye drops are not used.

Treatment for cataracts involves surgery to remove the lens of the eye. This is done as a day surgery, meaning that your child does not need to stay overnight at the hospital. There are no medications or laser treatments for cataracts and they do not go away on their own. Some mild cataracts, which do not affect vision, need no treatment at all. For more information on cataract surgery, visit www.pgcfa.org.

Glaucoma in JIA

Glaucoma occurs when the pressure inside the eye is too high. This can damage the optic nerve, which is the nerve that transmits messages from the eye to the brain. Damage of the optic nerve can lead to vision loss or even blindness if not treated. Pressure in the eye can increase either from iritis, or from the corticosteroids used to treat iritis.

There are usually no symptoms to warn that your child has glaucoma.

Checking for glaucoma should be part of your child's regular visits to the ophthalmologist or optometrist. Because glaucoma can arise in people with iritis, prevention is key. If your child does have glaucoma, they should be under the care of an ophthalmologist. The first line of treatment is eye drops or medication taken by mouth. If that doesn’t work, then your child may need surgery. For more information, see www.pgcfa.org.

Jennifer Stinson RN-EC, PhD, CPNP

Lori Tucker, MD

Adam Huber, MSc, MD, FRCPC

Lynn Spiegel, MD, FRCPC

Laura Schanberg, MD

Patrick McGrath, OC, PhD, FRSC​