Young people with arthritis are at risk of eye inflammation, called iritis. To help manage iritis, your child may be prescribed eye drops or other systemic medications. Regular eye exams are also important for managing and monitoring eye conditions.
Regular eye exams
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 child's eyes need to be checked regularly by an ophthalmologist or optometrist. If your child has no active eye inflammation, they should still have regular eye check-ups.
Patients can develop eye inflammation when their joints are in remission. Therefore, even if a child's joints are quiet, and they don’t need to see their rheumatologist as often, they still need to keep up with their eye-screening visits.
The rheumatologist will tell you how often your child's 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 arthritis was diagnosed before age seven
- If a blood test shows a positive anti-nuclear antibody (ANA).
If either of these applies to your child, they will need to be seen more often for the first five years after diagnosis of JIA.
During the eye exam, the eye doctor may put special drops in your child's eye to temporarily make the 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. Your child 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. Your child will simply put their chin on a special rest while the doctor looks at their eyes.
The frequency of eye exams will depend on your child's risk of developing eye problems. The eye doctor and rheumatologist will decide how frequently your child should have their eyes checked.
Eye drops
To help manage any eye inflammation (iritis/uveitis) your child may develop, the doctor might prescribe eye drops, such as steroids or pupil dilators. It is important to ask why your child needs 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 the 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 child's 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 eye inflammation. The 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.