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Eye and Vision Care

Psoriatic/Rheumatoid Arthritis w/ Blue Sclera

12/30/2009

Question:

I am 44 yrs old female and have psoriatic arthritis w/rhumatoid overlap. also psoriasis since teens. diagnosis of arthritis came 12yrs ago after foot reconstruction. I have been on remicade/methotrexate for 8 yrs and worked great but due to a hurricane missed aprox 7mos treatment. I have been back on 6mos but I noticed my scleras turning blue at that time. I have used steroid ointments (lidex .05%) long term but not at all for first 6 1/2 yrs of remicade and barely since then ie: 1 each 60ml tube and solution still not empty. I took prednisone only 2 days over 1yr ago. I do have eye pressure but it seems to be when my sinuses are acting up from allergies this time of the year.(normal for me) I don`t think my vision has been affected so far. My rhumatologist doesn`t have any answers for for me. I did have a vitamin d deficiency and responded well to temporary 50,000iu. The last two months, I am finally feeling the good effects of the remicade again. The blue sclera happened suddenly overnight and does not seem to be getting worse for now. My question is...could this be related to the arthritis? am I going to go blind? if so how long do I have? Should I start looking into facilities for the blind now to be prepared for the worst? Is there a possibility of eye transplants if these go bad? Am I unnecessarily worrying over nothing? I would appreciate any advice. thanks

Answer:

There are a number of conditions that can cause the sclera (the white outer, protective layer of the eye) to become blue. These conditions can cause thinning of the sclera, allowing the underlying pigmented layer of the eye to show through.

Conditions that may cause the sclera to appear blue include connective tissue and collagen disorders. Rheumatoid arthritis can also cause the scleral tissue to become thin. I do recommend having a comprehensive dilated eye exam with an eye care practitioner to rule out any arthritic-related ocular inflammation that may be causing the sclera to appear blue.
 
Upon examination, your eye doctor will be better able to address your visual and ocular health prognosis. Best of luck and thank you for your question!

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Response by:

Julia Rae Geldis, OD, MS Julia Rae Geldis, OD, MS
Clinical Assistant Professor of Optometry
College of Optometry
The Ohio State University