Even the Eye Suffers from Rheumatism

by Renato Alberto Meduri

"Greeks were the first to make a distinction between the regular tears shedded by the eye and those expressing anxiety and pain."

In every organ and system there is a special type of tissue, characterized as being connective, which carries out very important life functions.
Just like our whole body, the connective tissues are subject to the ageing process or diseases which include rheumatic diseases.
Since connective tissues are mainly found in bones, articulations, and tendons, rheumatism therefore affects this structure. Generically, we speak of arthrosis when it is of the degenerative type or of arthritis when the main cause is an injury with prevalent inflammatory and immunological responses.
Even the eye has connective tissues. The sclera, the eye's external white shell, is connective tissue with few vessels and nerves. Scleromalacia is the degenerative thinning of the sclera occurring in adults and older persons causing atrophy and perforation of the sclera visible as dark spots and jagged sides. Except in extreme situations, a specific therapy is not required when there are no symptoms (visual problems and pain).
Even the conjunctiva, the membrane that covers the external surface of the eye, and the uvea, the pigmented inside lining of the eye, are rich with connective tissues which can be affected by rheumatic diseases. In these cases, the symptoms can be the following: pain in the ocular globe more or less intense which sometimes can be accentuated following prolonged visual application, redness of the eye without secretion, visual loss, intolerance to light, characteristics of other syndroms (lupus, scleromalacia, Wagner's disease, etc.).
In infants and school-age children, recurring inflammation can result in the horizontal band-shaped opacification of the cornea beginning on the periphery, but in more advanced cases affecting the central portion of the eye which causes important visual loss.
The manifestation of pathologies of connective tissues can even involve selectively at times the glandular system responsible for the lubrification of the eyeball's surface and the production of tears.
In its lighter forms, they can cause simple eye dryness with difficulties to open eyelids upon awakening, feeling of heaviness at night, pronounced sensitivity to irritating agents and a general sense of discomfort. The more serious forms can lead to painful cornea with formation of small areas of mucosal epithelium, areas of thickening of the conjunctiva, a severe sense of discomfort and intolerance to light. The most common syndrome is that of Sjögren. It affects the immune system, targets moisture-producing glands and causes dryness in the mouth and eyes. The association between arthritis and this syndrome was first documented in 1889 by Fisher, but way before that Hippocrates (460 B.C. - 370 A.C.), physician known as the father of medicine, had associated arthritis and lumbago with the dry eye.  Therefore, the importance of tears had already been well understood in ancient Greece; they were gathered in small phials and given an emotional meaning. Greeks first subdivided tears in two typologies: those characteristic to the eye (basic secretion) and those expressing anxiety and pain (main lachrymal gland).
It is a very important chapter for the eye specialist, whether it is for the importance of its effect or the new knowledge which are emerging from numerous experimental and clinical studies outlining the possibility of therapeutic strategies that are more selective and effective.