by K. Molnar-Kimber, Ph.D.
The eyes of rheumatoid arthritis patients may develop symptoms like dry or red eyes, foreign-body sensation, pruritus (itchy eyes), light sensitivity, pain, visual changes, and even complete loss of vision (1-3). Another occasional consequence of RA is called the “corneal melt” which is a chronic ulcer of the cornea.
In a survey of 636 patients, the eyes of rheumatoid arthritis patients showed extreme dryness (Ocular sicca symptoms) in more than one third of patients. Reduced tear production occurred in 29% or about 3 of every 10 patients (3).
About one half of RA patients reported dry mouth (oral sicca symptoms). Both dry mouth and dry eyes were found in about 17% of RA patients or about 1 in every 6 patients (3). The minimum frequency of secondary Sjogren's syndrome was 7%.
Most physicians will opt to manage the symptoms in the eyes of rheumatoid arthritis patients with nonsteroidal anti-inflammatory drugs, corticosteroids, and immunosuppressive agents.
Most physicians have observed that when these medications control the systemic symptoms of RA, then they are more successful at controlling the ocular symptoms (1). When visual function is threatened, surgical therapy may be necessary (1).
In a 26 yr retrospective study of the visual ability of eyes of RA patients, those patients who were on DMARDs retained significantly more visual ability than those who did not take DMARDs (4).
Thus, these data suggest to me that improving your health to minimize or block the progression of RA can also benefit your eyes.
One team suggests that the parasympathetic nervous system does not function correctly in RA patients (5). This would affect the production of tears and thus also the feeling of dryness in the eyes of rheumatoid arthritis patients.
Another possibility is that the RA patients are chronically dehydrated.
Whether significantly increased water and trace minerals may slow the progression of the disease in the eyes of rheumatoid patients has not yet been reported. Oral rehydration using water containing physiologically similar levels of salt with trace minerals and glucose appears to be most beneficial and well tolerated in other diseases (6).
Thirdly, many parts of the eyes concentrate glutathione (7, 8). Glutathione plays many roles including normal tissue hydration (in the cornea), detoxifying substances using its pathways and protecting against light induced damage (8).
Many RA patients are low in glutathione and have reduced activity of their glutathione detoxification pathway (9-11).
I propose that the often poor health of eyes of rheumatoid arthritis patients may be partially caused by low concentrations of glutathione.
Raising glutathione levels may also benefit your eyes of rheumatoid arthritis patients. Here are several methods that raise glutathione levels in people:
1. intravenous administration,
2. taking supplements and
3. eating foods that stimulate glutathione’s production.
I personally use all of them. Update: I previously had received intravenous glutathione injections for my rheumatoid arthritis which helped to stop a flare (12). I now rely on taking the building blocks of glutathione (600 mg N-acetyl-cysteine, usually once daily with food) and eating foods that boost glutathione levels.
Fourth, many antioxidants like lutein, zeaxanthin and astaxanthin, are concentrated in the eyes (13). Again, rheumatoid arthritis patients are often low in antioxidant activity.
I propose that raising antioxidant levels may also benefit the eyes of rheumatoid arthritis patients, like your eyes.
Since I began taking bilberry and astaxanthin, I’ve noticed that my night vision has improved.
1. Patel, S. J., and D. C. Lundy. 2002. Ocular manifestations of autoimmune disease. Am Fam Physician 66:991.
2. Punjabi, O. S., R. S. Adyanthaya, A. D. Mhatre, and R. P. Jehangir. 2006. Rheumatoid arthritis is a risk factor for dry eye in the Indian population. Ophthalmic Epidemiol 13:379.
3. Uhlig, T., T. K. Kvien, J. L. Jensen, and T. Axell. 1999. Sicca symptoms, saliva and tear production, and disease variables in 636 patients with rheumatoid arthritis. Ann Rheum Dis 58:415.
4. Saripalli, L., T. M. Harrington, R. G. Notz, and D. Torretti. 2005. Corneal melt in rheumatic disorders: effect of disease-modifying antirheumatic drugs on morbidity. J Clin Rheumatol 11:134.
5. Barendregt, P. J., G. L. van der Heijde, F. C. Breedveld, and H. M. Markusse. 1996. Parasympathetic dysfunction in rheumatoid arthritis patients with ocular dryness. Ann Rheum Dis 55:612.
6. von Hattingberg, H. M. 1992. Water: mechanism of oral rehydration, water deficiency = deficiency in salt. Methods Find Exp Clin Pharmacol 14:289.
7. Giblin, F. J. 2000. Glutathione: a vital lens antioxidant. J Ocul Pharmacol Ther 16:121.
8. Megaw, J. M. 1984. Glutathione and ocular photobiology. Curr Eye Res 3:83.
9. Hassan, M. Q., R. A. Hadi, Z. S. Al-Rawi, V. A. Padron, and S. J. Stohs. 2001. The glutathione defense system in the pathogenesis of rheumatoid arthritis. J Appl Toxicol 21:69.
10. Sarban, S., A. Kocyigit, M. Yazar, and U. E. Isikan. 2005. Plasma total antioxidant capacity, lipid peroxidation, and erythrocyte antioxidant enzyme activities in patients with rheumatoid arthritis and osteoarthritis. Clin Biochem 38:981.
11. Kamanli, A., M. Naziroglu, N. Aydilek, and C. Hacievliyagil. 2004. Plasma lipid peroxidation and antioxidant levels in patients with rheumatoid arthritis. Cell Biochem Funct 22:53.
12. Molnar-Kimber, K. L., H. E. Buttram. 2008. Patient Report: Evidence that Intravenous Administration of Glutathione and Vitamin C Relieved Acute Pain from Rheumatoid Arthritis Flare. Townsend Letter for Physicians and Patients. Nov. (305): 60-61.
13. Trevithick-Sutton, C. C., C. S. Foote, M. Collins, and J. R. Trevithick. 2006. The retinal carotenoids zeaxanthin and lutein scavenge superoxide and hydroxyl radicals: a chemiluminescence and ESR study. Mol Vis 12:1127.
Please note that the information on this website is a sharing of information and knowledge from the research and experience of Dr. Molnar-Kimber and her community. It is not intended to replace your one on one relationship with a qualified health care professional. It also is not intended to be medical advice. However, it is often observed that patients who take a major interest in their disease and learn as much as they can about their disease and potential treatments often improve faster than those who don’t. Dr. Molnar-Kimber encourages you to make your own health care decisions based upon your own research and discussions with your qualified health care professional.
The health of your eyes depends on many facets of life--the air quality, sun exposure, how often and how much you move your eyes, and available nutrients.
1. Beeswax candles give off less pollutants than paraffin-based candles.
2. Vary your focal point from close to far--at least 10 feet away. For example, look up from your reading, computer screen, nook, or kindle every 20 min to view outside or a wall at least 10 feet away. Why: A flexible lens that changes shape to focus at different distances is healthier.
3. Provide ample nutrients for your eyes, including many antioxidants --lutein from eggs, astaxanthin from wild Alaskan Salmon, and glutathione.