How Does Ankylosing Spondylitis Affect the Eyes?

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Ankylosing spondylitis (AS) is a type of inflammatory arthritis that typically affects the spine. This condition can cause issues with other joints of the body, and some internal organs, including the eyes. Of those affected by AS, around one-third also have uveitis (inflammation inside the eye).

This article discusses uveitis caused by ankylosing spondylitis, including its symptoms, why it occurs, how it is treated, and how to prevent it.

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Types of Uveitis

The eye has three layers, the middle of which is called the uvea. The uvea contains many blood vessels and is made up of the iris, the ciliary body, and the choroid. Uveitis is a condition that occurs when the uvea is inflamed.

There are four types of uveitis that affect different parts of the uvea. They are:

  • Anterior uveitis is the most common type and affects the iris, or colored part of the eye.
  • Intermediate uveitis occurs when the ciliary body and fluid in the middle of the eye are inflamed. The ciliary body helps the lens of your eye focus.
  • Posterior uveitis affects the choroid and retina in the back of the eye.
  • Panuveitis occurs when all the parts of the uvea are inflamed.

Anterior uveitis is the most common type of eye inflammation that occurs with ankylosing spondylitis.

Why AS Is a Risk Factor for Uveitis

Ankylosing spondylitis is an autoimmune condition causing inflammation throughout the body. The body's immune system attacks healthy tissues—including the uvea—because it mistakenly believes it is harmful. Uveitis is a common clinical sign of many types of inflammatory disease.

The exact reason why uveitis occurs with AS is not clear, but researchers have found that people with both conditions often have a specific mutation of the HLA-B27 gene. However, not all people with AS and uveitis have this genetic marker.

Symptoms of Uveitis

Uveitis can affect one or both eyes. Symptoms include:

  • Floaters (dark shapes or squiggly lines that "float" in your vision)
  • Eye redness
  • Pain in the eyes
  • Blurry vision
  • Sensitivity to light

Complications from uveitis can also occur, especially if left untreated. These include:

Treatment for Uveitis

Medications used to treat ankylosing spondylitis can help reduce inflammation throughout the body, including the eyes. These include:

  • Corticosteroid eye drops: These medications interrupt gene pathways to control inflammation. In some cases, steroid medications may be injected into the eye. Your eye doctor will determine the best steroid drop for you. Increased pressure can be a side effect of both steroids and uveitis, so it is important to follow up with your eye doctor if you feel any change in eye pressure.
  • Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs): These medications help reduce pain and inflammation early in the disease process. Examples include Aleve (naproxen), Advil (ibuprofen), and Bayer (aspirin).
  • TNF (tumor necrosis factor) blockers: These drugs target a protein called tumor necrosis factor that causes inflammation in the body. There are several different TNF blockers, but Humira (adalimumab) or Remicade (infliximab) are often tried first.
  • IL-17: This is another type of biologic drug that might be prescribed if TNF blockers are ineffective. These medications target an inflammatory protein called interleukin-17. Examples of IL-17 drugs include Cosentyx (secukinumab) and Taltz (ixekizumab).

Preventing Uveitis

Chronic uveitis is common with ankylosing spondylitis. While it can't always be prevented, regular checkups with your healthcare provider can help you recognize the early signs of a flare-up and start treatment to avoid permanent damage.

Summary

Uveitis affects around one-third of people who have ankylosing spondylitis—an inflammatory condition that primarily affects the spine. Uveitis causes eye redness, pain, blurry vision, floaters, and, if left untreated, can lead to permanent blindness. Treatment includes medications that reduce inflammation throughout the body and steroid drops or injections to the affected eye.

A Word From Verywell

If you're living with ankylosing spondylitis, it's important to recognize if inflammation spreads to other parts of your body, including your eyes. Even if you don't have symptoms of uveitis, consider seeing a healthcare provider to establish a baseline and schedule regular follow-up appointments to monitor for early signs of this condition. Being proactive can prevent serious side effects down the road, including blindness.

Frequently Asked Questions

  • Does ankylosing spondylitis cause blurred vision?

    It can. Ankylosing spondylitis can cause inflammation throughout the body, including the eyes. This can lead to a condition called uveitis, which often causes blurred vision.

  • What are the early signs of ankylosing spondylitis?

    The most common early sign of ankylosing spondylitis is chronic low back pain and stiffness that gradually worsens over time. Pain from this condition usually improves with movement and gets worse with rest. Symptoms typically begin in people before the age of 40.

  • Does ankylosing spondylitis cause dry eyes?

    Ankylosing spondylitis can cause uveitis, or inflammation in the middle layer of the eye. Symptoms include redness, pain, blurred vision, floaters, and sensitivity to light. Dryness is not typically a symptom of this type of uveitis.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American College of Rheumatology. Ankylosing spondylitis & uveitis: an ophthalmologist's perspective.

  2. National Eye Institute. Uveitis.

  3. Oh BL, Lee JS, Lee EY, et al. Recurrent anterior uveitis and subsequent incidence of ankylosing spondylitis: a nationwide cohort study from 2002 to 2013Arthritis Res Ther. 2018;20:22. doi:10.1186/s13075-018-1522-2

  4. İnanç M, Şimşek M, Çakar Özdal MP. Etiological and clinical characteristics of hla-b27-associated uveitis in a tertiary referral centerTurk J Ophthalmol. 2019;49(1):10-14. doi:10.4274/tjo.galenos.2018.53896

  5. American Academy of Ophthalmology. Uveitis symptoms.

  6. Mitulescu TC, Trandafir M, Dimancescu MG, et al. Advances in the treatment of uveitis in patients with spondyloarthritis - is it the time for biologic therapy? Rom J Ophthalmol. 2018;62(2):114-122. doi: 10.22336/rjo.2018.17

  7. Ward MM, Deodhar A, Gensler LS, et al. 2019 update of the american college of rheumatology/spondylitis association of america/spondyloarthritis research and treatment network recommendations for the treatment of ankylosing spondylitis and non-radiographic axial spondyloarthritisArthritis Care Res (Hoboken). 2019;71(10):1285-1299. doi:10.1002/acr.24025

  8. Gupta N, Agarwal A. Management of uveitis in spondyloarthropathy: current trendsPerm J. 2017;22:17-041. doi:10.7812/TPP/17-041

By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public, specializing in the areas of orthopedic injury, neurologic diseases, developmental disorders, and healthy living.