Juvenile arthritis, also called juvenile rheumatoid arthritis or childhood arthritis, is the most common type of arthritis to affect children. It’s can affect many parts of the body, including the eyes.
The most common eye problem is inflammation in a part of the eye called the uvea. Doctors call this condition “uveitis.” If it affects specific parts of the uvea, it may also be called iritis or iridocyclitis.
Untreated and severe uveitis can scar the eye. It can also cause vision problems, such as:
- Glaucoma, a condition that causes high pressure in the eye
- Cataracts, a clouding of the lens of the eye
- Permanent vision damage, including blindness
Uveitis can start up to 1 year before your child gets a diagnosis of juvenile arthritis. Or it could happen at the same time, or years later. It can even happen years after juvenile arthritis is in remission, which means that the disease is not active.
How can I tell if my child is developing eye problems related to juvenile arthritis?
Eye inflammation may not be painful. And the eyes are not usually as red as they are in conjunctivitis. So many children with juvenile arthritis who develop eye problems may not have any obvious symptoms.
It’s rare, but a child might complain of blurred vision or of light bothering her eyes. Sometimes, a child's eyes might look red or cloudy. But these types of symptoms usually develop so slowly that permanent eye damage can happen before she notices any trouble with seeing.
In order to find eye problems early and prevent them from causing damage, your rheumatologist (a doctor who specializes in treating arthritis) will schedule frequent appointments with a pediatric ophthalmologist. That's a medical doctor who specializes in children’s eye diseases.
What will happen during my child's appointment with an ophthalmologist?
Tell the ophthalmologist about the medicines that your child takes. You can get the names of the medicines, the dosages, and the reasons they have been prescribed from your rheumatologist.
During the eye exam, the ophthalmologist will put drops in your child's eyes to make the pupils dilate. The drops may burn a little, but it helps the doctor get a clear view inside the eyes.
To diagnose eye inflammation, the ophthalmologist uses a special kind of microscope. With it, the doctor will shine a thin beam of light into one eye at a time so he can view the inside of each eye.
The doctor might also give your child a “visual field” test to check for any vision changes. This type of exam measures peripheral vision, meaning how far your child can see to the side when she focuses her gaze on a central point.
You should carefully follow the medicine guidelines that your child’s doctor provided. Keep all appointments with the rheumatologist and the ophthalmologist.
How often should my child have eye examinations?
That depends on what type of juvenile arthritis she has, how long she has had it, and what medications she takes. Ask your rheumatologist for the schedule.
Uveitis is more common in children with certain types of juvenile arthritis, such as what doctors call the “oligoarticular variant,” where just a few joints are affected. A child with this type of juvenile arthritis might need to get her eyes checked every 3 to 4 months. In general, children with polyarthritis need an eye exam every 6 months. Children with systemic juvenile arthritis usually need an examination every 12 months.
Your child should also keep up with her eye tests after the juvenile arthritis goes into remission.
If any eye problems turn up, your child will need to get checked more often.
What’s the treatment for eye problems linked to juvenile arthritis?
Your rheumatologist and ophthalmologist will work with you on this. If your child has uveitis, she might need prescription eyedrops.
Some of these eyedrops dilate the eyes in order to keep the pupils open and help to prevent scars.
Your child might also be prescribed steroid eyedrops. For example, your child might use cortisone drops to curb swelling and lower inflammation. Long-term use of steroid eyedrops can have serious side effects, including glaucoma and cataracts.
If eyedrops don’t lower inflammation enough, your child might need to take anti-inflammatory pills. To avoid long-term side effects of steroid medications, your child might also get a drug such as methotrexate, which they would take by mouth or as a shot.
Severe cases of uveitis may need different kinds of drugs that treat immune system conditions.