Eye Problems and Juvenile Idiopathic Arthritis

Uveitis in JIA

Uveitis is an eye inflammation that can reduce vision. Uveitis happens with some forms of juvenile idiopathic arthritis (JIA). It does not matter how severe the JIA is. In fact, uveitis is most common in children and teenagers with only one or a few joints involved. Uveitis may even start before the JIA is diagnosed. 

Uveitis is also not related to how active the JIA is. A child's joints can be going through a bad period while his 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. It can start in one eye and later involve the other eye. Or it can start in both eyes at the same time. However, if a child has had uveitis in only one eye for six to 12 months, he is not likely 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. A child may not be aware that he has it. Therefore, it is important that children with JIA have their eyes checked regularly, even if they are not red or painful. Iritis is treated with corticosteroid eye drops or other medications, and this will help prevent blindness.

JIA can sometimes cause uveitis - eye inflammation - in other parts of the eye. These other types of inflammation are less common but more severe in terms of decreasing 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 doctor specially trained in eye care and treatment. An optometrist is a health care professional who can diagnose eye problems. Children and teenagers with JIA must have regular eye checks 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 children and teenagers are rare, but they can occur in 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 if there is a cataract. Depending on how much and which part of the lens is cloudy, the 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 in part depend on the amount and length of time over which the corticosteroids are used. Some children and teenagers seem more sensitive to this than others for reasons we do not 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 the child or teenager does not need to stay overnight at the hospital. There are no medications or laser treatments for cataracts and they do not go away by themselves. 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.

There are usually no symptoms to warn that someone has glaucoma.

Pressure in the eye can increase either from iritis, or from the corticosteroids used to treat iritis. 

Checking for glaucoma should be part of a child's regular visits to his ophthalmologist or optometrist. Because glaucoma can arise in people with iritis, prevention is key! If a child does have glaucoma, he 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 he may need surgery.

For more information, see www.pgcfa.org

Tania Cellucci, MD, BSc(Hons), FRCPC

Adam Huber, MSc, MD, FRCPC

Alex V. Levin, MD, MHSc, FAAP, FAAO, FRCSC

Patrick J. McGrath, PhD

Laura E. Schanberg, MD

Lynn Spiegel, MD, FRCPC

Jennifer Stinson, RN, PhD, CPNP

Lori B. Tucker, MD