Spondylitis Eye Inflammation: Symptoms, Diagnosis and Management

Are you or a loved one living with spondylitis and having constant or recurring problems with your eyes, on top of dealing with chronic back pain? You’re not alone — many members of MySpondylitisTeam report experiencing painful eye inflammation called uveitis (or iritis). According to the Spondylitis Association of America, as many as half of the people with spondylitis will have uveitis at least once.

Here’s what uveitis is, what causes it, and how it can be treated.

What Is Uveitis?

Uveitis means that there is inflammation (a process in which your body’s immune system reacts and attacks) in a part of your eye called the uvea. Despite the name, uveitis may sometimes affect other areas of the eye.

What Is the Uvea?

The uvea is essentially the middle part of the eye. The front of your eye is called the cornea, and the outer part, or the white part, of your eye is called the sclera. The very back of your eye is the retina, where colors are detected and passed on to your brain as vision through a big nerve called the optic nerve.

In between these front and back parts of the eye is the uvea, which also includes:

• The iris (the colored part of the eye)
• The choroid (where many blood vessels that supply oxygen and nutrients to the eye are located)
• The ciliary body (which produces the essential fluid within the eye)

Types of Uveitis

Because the uvea takes up so much of the eye, uveitis is divided into subtypes depending on the region involved. Spondylitis can affect one or more of these regions.

Anterior uveitis occurs toward the front of the eye, where there will be noticeable redness. Symptoms usually start suddenly (called acute anterior uveitis), typically lasting many weeks, and may return once in a while. Intermediate uveitis occurs in the middle of the eye. Posterior uveitis occurs toward the back of the uvea. Symptoms usually develop slowly and stay for many years.

Panuveitis is uveitis that happens across all three areas of the eye.

Symptoms of Eye Inflammation in Spondylitis

Symptoms of uveitis can affect one or both eyes and include:

• Pain
• Redness
• Sensitivity to light
• Vision changes such as blurred vision, floaters, or decreased vision
• Drooping eyelid
• Tearing

MySpondylitisTeam members describe different symptoms they experience with eye inflammation, including:

• “Terrible eye pain”
• “Burning, dryness, blurring, bloodshot appearance”
• “Felt like sandpaper”
• “Photophobia, severe eye pain and pressure, and seeing spots with blurry areas in my vision”
• “Red, dry, and blurry vision”

Other members said, “It felt like grit, and I couldn’t get any relief from it,” and, “It feels like a hot poker or ice pick in the eye, accompanied by redness and extreme sensitivity to light.” Some members also report having blepharitis (inflammation of the eyelids) and episcleritis (inflammation of the clear layer over the white of the eye).

Complications

If not treated, uveitis can eventually lead to glaucoma, which is when pressure from eye fluid builds up within the eye. Glaucoma can result in blindness. Vision loss can also result from damage to other important parts of the eye like the retina.

Connecting Eye Inflammation to Spondylitis

Some people with spondylitis do not immediately recognize their eye inflammation as a symptom. For example, one member wrote, “Not a bad day today, just having a problem with my eyes. This is really starting to worry me a lot. Does anyone have a clue?” Another wrote, “Has anyone had their AS [ankylosing spondylitis] affect their eyes? I have experienced various eye issues over the past couple of years.” In both conversations, other members quickly responded that, yes, eye inflammation is common in spondylitis and recommended speaking with a doctor about treatment.

For other members, eye inflammation was key to getting diagnosed with spondylitis. “I was quickly diagnosed with AS because of eye involvement as well as pain,” wrote one MySpondylitisTeam member. “The eye issues led to my diagnosis a few years ago,” said another.

Diagnosing Uveitis in Spondylitis

Ophthalmologists (doctors specializing in eye and vision care) will perform a thorough eye exam to diagnose uveitis. An ophthalmologist can also use tools like a slit-lamp (a specialized microscope) to look more closely at the eye and see if the uvea is inflamed.

An important part of diagnosing uveitis is also understanding your medical history of spondylitis, another systemic disease, or an autoimmune condition. Having an autoimmune condition like spondylitis, rheumatoid arthritis, psoriatic arthritis, and reactive arthritis makes uveitis much more likely than other causes of redness in the eyes.

There are genetics involved in spondylitis and uveitis, too. A protein called HLA-B27 is often found in people with spondylitis. Testing for HLA-B27 may be needed to confirm spondylitis-related uveitis.

In some cases, your doctor may want to run X-rays to rule out other possible causes of uveitis such as sarcoidosis and tuberculosis.

Treatment and Management of Uveitis

In general, many of the treatments for uveitis are similar to those for spondylitis. These treatments include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for pain, corticosteroids as needed for flares, and biologics such as tumor necrosis factor (TNF) inhibitors.

Many MySpondylitisTeam members report that treatments for spondylitis have also helped with their uveitis. For example, one member shared, “My rheumatologist said Humira has something in it that helps the eyes directly. Iritis is recurring, so if you can get on Humira, I would.” In another conversation, a member wrote that he was starting methotrexate due to a bout of uveitis. Another member wrote in support, “I’ve been on methotrexate for about 10 years now. It’s helped me a lot, along with the Rituxan infusions.”

For uveitis specifically, there are ocular forms (eye drops) of many of these medications or intraocular eye injections that can be used for pain and redness.

Talk to your doctors about your current medications and symptoms. They can recommend specific treatments that work best with your symptoms and situation, while minimizing side effects that might come with some of these drugs.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. More than 66,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you or a loved one living with eye inflammation and spondylitis? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.