A variety of disorders are classified within the umbrella of autoimmune diseases. These disorders include rheumatoid arthritis, sjogren’s syndrome, Wegeners granulomatosis, systemic lupus erythematosus, multiple sclerosis, giant cell arteritis, and Graves’ disease. All of these disorders can have a variety of systemic and ocular effects. An eye expert witness for autoimmune disease may determine the diagnosis and treatment options for these patients.
Ocular symptoms may include eye irritation, redness, itching, light sensitivity, and changes in vision. Most ocular complications involve the conjunctiva and cornea, but may also involve the sclera, uveal tract, ocular muscles, retina, and optic nerve. Redness and irritation of the eye are signs of possible involvement of the conjunctiva and cornea.
One of the most common ocular manifestations of rheumatoid arthritis and Graves’ disease is dryness of the eye. An eye expert witness for autoimmune disease may scrutinize a medical record for evidence of dryness of the eye associated with these conditions. The incidence of dryness of the eyes in individuals with rheumatoid arthritis has been reported to occur in about 15 to 25 percent of these patients.
Clinical examination may show signs of dryness involving the conjunctiva or cornea. Examination of the tear film and luster of the cornea are parameters that are evaluated by an ophthalmologist with a slit lamp. In cases of severe dryness, small erosions of the surface of the cornea or filaments may be seen with the aid of a slot lamp. A Schirmer’s tear test is often utilized to ascertain the level of production of tears by the tear gland. The Schirmer test is simple, non-invasive, and readily performed by an ophthalmologist. An eye expert witness reviews pertinent records for this and other findings that indicate association with autoimmune disease.
Patients with autoimmune disease can develop redness of the eye for a number of reasons. Conjunctivitis due to dryness is a common association with autoimmune disorders. Scleritis or episcleritis is an inflammation involving the outer wall of the eye that is most commonly associated with rheumatoid arthritis. Scleritis may cause deep pain that is exacerbated by even gentle palpation.
About twenty percent of individuals with systemic lupus erythematosus (SLE) develop eye problems. Dryness of the eyes, inflammation of the uveal tract (uveitis), corneal disease, and a reash involving the eyelids may be seen as a manifestation of autoimmune disease. Retinal disorders, most commonly a vasculitis of the retinal blood vessels are uncommonly seen in individuals with systemic lupus erythematosus. Damage to the circulation of the retina may result in so-called cotton-wool spots that may be detected by an eye expert witness for autoimmune disease.
Senior citizens and in particular individuals with rheumatoid arthritis can develop a potentially devastating condition known as giant cell arteritis. Inflammation of blood vessels supplying the retina and optic nerve may become affected in giant cell arteritis. A sign of giant cell arteritis is when the temporal artery, located along the side of the forehead, becomes tender and inflammed. Biopsy of the temporal artery in the presence of giant cell arteritis often shows granulomatous inflammation. An eye expert witness for autoimmune disease may evaluate diagnostic methods and treatment in patients with giant cell arteritis.
Individuals with autoimmune disease may be evaluated by an eye expert witness to determine the presence and severity of ocular involvement. Once the diagnosis has been established, the options for treat may be evaluated.