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Ankylosing Spondylitis and Eyes: Diagnosis, Treatment, and Floaters?

Feb 9, 2023
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Although ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine, it can affect other body parts like your eyes. It is estimated that 40% of people with AS develop inflammation of the eyes.

Those who suffer from AS and whose eyes are affected may experience light sensitivity, eye pain, and increased floaters (spots in your vision).

In this article, we will discuss how AS can affect the eyes, how to identify eye problems, and its treatment.

Ankylosing spondylitis eye treatment

About 40% of people with AS have eye inflammation. An attack of eye inflammation may cause sudden eye pain (typically in one eye), redness, light sensitivity, and decreased vision. Allowing your eyes to rest and using warm compress can help with mild eye pain. You can make a warm compress at home by warming up a face cloth with hot water.

Often, medications are needed to control inflammation and prevent it from spreading and causing more damage. Your doctors may prescribe you eye drops (corticosteroids and pupil-dilating drops) as the first line of treatment to ease your symptoms and pain . If the eye drops do not work, corticosteroid injections or pills are added to manage the symptoms. In some cases, other types of immunosuppressants like methotrexate or sulfasalazine may be added, allowing dose tapering of steroids.

In severe eye inflammation, a procedure known as vitrectomy may remove a gel-like substance in the eye. Alternatively, in severe cases, surgery can be done to insert a device that releases corticosteroids medication over a long period may be recommended.

Ankylosing spondylitis eye floaters

When AS causes eye inflammation; this condition is called uveitis. Uveitis is often accompanied by eye pain, light sensitivity, and increased spots in your eyes (floaters).

Eye floaters usually look like grey or black specks or cobwebs that drift when you move your eyes. When you try to look at floaters, they tend to drift away from your field of vision.

Uveitis In ankylosing spondylitis

AS is a systemic condition that can affect different body areas and cause inflammation. Sometimes,  uveitis could be the first sign of ankylosing spondylitis, indicating that you have a systemic disease.

Uveitis can be diagnosed through an eye examination and exploring your full medical history.

The eye examination includes:

  • Ocular pressure test (a test that measures eye pressure)
  • Eye chart test (a test that determines if you have any vision problems)
  • A slit lamp exam (an eye examination that checks the health of your entire eye, including the blood vessels)
  • Fundoscopic exam (a checkup that examines the back of the eye)

Ankylosing spondylitis and dry eyes

Dry eyes are common in people with AS. Often, eye specialists use the dry eyes technique to help them diagnose ankylosing spondylitis. Dry eyes occur due to higher instability in the surface of your tear film than average.

HLA-B27 and eye disease

HLA-B27 is a gene that is strongly linked to ankylosing spondylitis, particularly eye disease related to AS. About 88% of the people with AS are HLA-B27 positive. Also, 40-70% of patients with HLA-B27 have uveitis.

Ankylosing spondylitis diagnosis

Doctors rely on symptoms, physical examination, imaging tests, and blood tests to diagnose ankylosing spondylitis.

Your doctor may recommend for you to have an X-ray, CT scan, or an MRI scan to examine your joints and bones for ankylosing spondylitis. MRI provides detailed images of bones and soft tissues around the joints that can help  identify ankylosing spondylitis.

There are no specific blood tests that confirm ankylosing spondylitis. However, some inflammatory markers can be used to identify the disease. A blood test for the HLA-B27 gene can also be done, but it is not a confirmatory test suggesting ankylosing spondylitis.

Ocular migraine and ankylosing spondylitis

Ocular migraine and flares of uveitis (due to ankylosing spondylitis) can often be mistaken for each other. They both have similar symptoms: decreased vision, affecting one eye, sudden onset, and flashes or floaters. However, their causes are quite different. Ocular migraine usually lasts for an hour and is often associated with headache. It is caused by constriction of blood vessels to the eyes. On the other hand, ankylosing spondylitis uveitis is caused by inflammation and doesn’t usually cause headache.

Ankylosing spondylitis symptoms in women

The incidence of AS is more common in men. However, many women also suffer from AS. Many females experience typical symptoms, such as pain in the lower back that tends to get worse with rest and get better with physical activity. However, women also experience other atypical symptoms.

The other atypical symptoms may include:

  • Redness in eyes
  • Abdominal pain
  • Diarrhea
  • Frequent mouth sores
  • Irregular nails
  • Psoriasis (a skin disorder)

Typical symptoms of AS include:

  • Pain and stiffness in the lower back
  • Hip pain
  • Joint pain
  • Loss of appetite
  • Skin rash
  • Neck pain
  • Fatigue
  • Abdominal pain
  • Breathing difficulty 

What medications can help with ankylosing spondylitis

The doctors usually use the following medications for ankylosing spondylitis:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) The doctors commonly use these medications as they help to reduce inflammation, pain, and stiffness. Some examples of NSAIDs include ibuprofen and naproxen. NSAIDs are also useful for treating uveitis or eye inflammation associated with ankylosing spondylitis.
  • Interleukin-17 inhibitor – In some cases, your doctor may prescribe you an interleukin-17 inhibitor to treat ankylosing spondylitis. Some examples include Secukinumab and Ixekizumab. 
  • Tumor necrosis factor (TNF) blockers - When NSAIDs are not helpful, your doctor may prescribe you TNF blockers. These medications are injected under your skin or intravenously. Some examples of TNF blockers include Infliximab, Adalimumab, Etanercept, and Certolizumab. 

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