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Eye damage in rheumatism
Last reviewed: 07.07.2025
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The basis of tissue changes in rheumatism is the systemic disorganization of connective tissue, most profound in the heart and blood vessels, in combination with specific exudative-proliferative reactions and damage to the vessels of the microcirculatory bed, found in all organs.
Changes in the organ of vision in rheumatism most often manifest themselves in the form of toxic-allergic uveitis, vasculitis and retinovasculitis, which can affect both the arteries and veins of the retina and proceed as peri- and panangiitis.
In arterioles and arteries, destructive-proliferative vasculitis, perivascular cellular infiltration, sometimes plasma impregnation, fibrinoid swelling and necrosis of the vessel wall, and less often thrombosis develop.
In retinovasculitis, grayish cuffs and point hemorrhages form around the vessels of the 2nd to 4th order. The cuffs may involve several vessels. Due to macular edema, a slight decrease in visual acuity is possible.
Rheumatism is characterized by a tendency to intravascular thrombosis, so obstruction of the central retinal artery or vein may occur. In such cases, a significant decrease in visual acuity is noted.
The diagnosis of rheumatic vasculitis is easier to establish if there are cuffs or a "lining" located on one side of the vessel, which resembles snow on a tree branch - a pathognomonic symptom of rheumatism. With widespread damage to arteries and veins with the involvement of vascular branches on the optic disc, the course of rheumatic perivasculitis is very severe.
An exudate may appear on the optic disc, covering the vascular infundibulum and most of the disc surface in the form of a grayish cap. Multiple retinal hemorrhages, fibrin deposits, and sometimes a star-shaped figure in the macular area are possible.
Early treatment (in collaboration with a rheumatologist) leads to the reverse development of the process and restoration of vision. Rheumatic retinopathy rarely develops in children.
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