Ankylosing Spondylitis and Uveitis: Eye Warning Signs to Know
Uveitis is inflammation inside the eye, and it's the most common problem outside the joints for people with ankylosing spondylitis (AS). Around a third of people with AS have at least one episode. It's very treatable, but it needs prompt attention, so knowing the signs matters.
Why it's linked to AS
The type that goes with AS is acute anterior uveitis, inflammation at the front of the eye around the iris. It's closely linked to the HLA-B27 gene, which most people with AS carry, and it's part of the same inflammatory process that affects the spine and joints. It can happen at any point, including before AS has been diagnosed, and sometimes it's the first clue.
The warning signs
It usually affects one eye at a time and comes on over hours to a day or two:
- a red eye, often reddest in a ring around the coloured part
- eye pain or an ache, sometimes deep
- sensitivity to light, which can be striking
- blurred or misty vision
- watering
Uveitis is usually not sticky or gritty in the way conjunctivitis is. A painful, light-sensitive red eye in someone with AS should be treated as uveitis until shown otherwise.
What to do
Get your eye checked the same day. Depending on where you live, that means an urgent eye clinic or eye emergency department, an optometrist who offers urgent appointments, or your doctor's same-day service. Say you have AS and suspect uveitis. Diagnosis needs an examination with a slit lamp, which most GPs don't have.
Treatment is usually steroid eye drops, often with drops that dilate the pupil to ease pain and stop the iris sticking to the lens. Treated early, most episodes settle within a few weeks. Left untreated, uveitis can lead to complications such as raised eye pressure, cataracts or lasting damage to vision.
If it keeps coming back
Uveitis often recurs, and it can affect the other eye next time. Tell your rheumatologist about every episode, because frequent uveitis can influence which treatment they recommend for your AS, and some biologics are better than others at reducing eye flares. Many people keep a note of how quickly to act and where to go, so they're not working it out with a painful eye.
Keep a record of every eye episode
Spondy tracks uveitis episodes alongside your spine and joint symptoms, flares and medications, so your rheumatologist sees the full picture.
This article is for general information and isn't a substitute for medical advice. Talk to a doctor about your own symptoms, tests and treatment.