Eye Problems: A Risk of Treatment

In addition to the problems that arthritis itself can cause, some medications used to treat arthritis can lead to problems themselves. One of the medications requiring special monitoring, in children and adults alike, is the antimalarial drug hydroxychloroquine (Plaquenil). It's part of a category of drugs called dease-modifying anti-rheumatic drugs (DMARDs), that actually slow disease progress.

While hydroxychloroquine doesn't damage the eyes the way inflammation does, it can deposit in the back of the eye and over time lead to color vision problems, says Dr. Howard. Fortunately, there are evidence-based guidelines for monitoring such therapy, and such monitoring can help prevent any noticeable effects on color perception or sharpness of vision.

Corticosteroids, including prednisone, which are prescribed to help control inflammation, can also lead to eye problems – chiefly cataracts. In general, it is rarer to see cataracts develop in children than adults. Nevertheless, any child taking corticosteroids regularly for any reason should have regular eye exams, says Dr. Howard.

Eye Problems and How They are Treated

Exams and treatment for arthritis-associated eye problems in children should be handled by a pediatric ophthalmologist (a medical doctor specializing in the diagnosis and treatment of eye diseases in children) working closely with your child’s rheumatologist.

Typically the first line of treatment is a steroid eyedrop to reduce inflammation. Sometimes doctors also prescribe an agent that dilates the pupils to prevent scarring.

When localized treatments aren’t enough to stop the problem, oral or injected medications may be necessary. The most commonly used systemic medication is methotrexate. In the event that methotrexate isn’t effective, the doctor may prescribe another DMARD such as cyclosporine (Neoral) or mycophenolate mofetil (CellCept) or one of a subcategory of DMARDs known as biologic response modifiers such as infliximab (Remicade).

If your child’s arthritis is active, these same medications may control both the arthritis and the related eye disease. In other cases, these drugs are used even if arthritis itself is quiet, says Dr. Howard.  “A lot of times the ophthalmologist will ask us to reinstitute a drug for a child whose joint symptoms have gone away,” he says. “At other times the ophthalmologist may ask the rheumatologist to increase the dosage of a drug that is already sufficient to control the joint disease.”

To a Better Life and Better Sight

With the many drugs available – for both local and systemic use – arthritis-related eye problems are highly treatable. Moreover, with frequent eye exams, says Dr. Howard, these problems are not only treatable, they are preventable.