Eye complications are not uncommon in people withrheumatoid arthritis(RA), an inflammatoryautoimmune diseasewhere your immune system mistakenly attacks your joints. These attacks causeinflammation, which leads to painful, swollen, and stiff joints. Chronic inflammation might eventually cause joint damage and disability.
RA is asystemic disease, meaning it can have whole-body effects. Systemic symptoms occur in people who have a more severe form of the disease. This could mean more inflammation to other parts of your body, including your skin, blood vessels, and eyes. Keep reading to learn about how RA can affect your eyes.
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Eye Complications of RA
RA can affect your eyes in many different ways, some of which might be more serious than others. Eye complications of RA includekeratoconjunctivitis sicca,episcleritis,scleritis, anduveitis.
Keratoconjunctivitis Sicca
Also known as dry eye syndrome, keratoconjunctivitis sicca is a common eye complication connected to RA.It occurs when the eyes cannot produce enough or any tears. While there are a number of conditions that may cause dry eyes, RA and a condition known asSjögren’s diseaseare the most common causes.
Dry eye syndrome can cause mild or severe symptoms. Symptoms include:
It is important to treat dry eye syndrome to avoid the risk of eye infection or damage to the cornea. Dry eye syndrome can be managed effectively, and treatment is usually dependent on the underlying cause, symptoms, and severity.
Mild cases can respond well to over-the-counter eye drops, while severe cases might require prescription eye drops, anti-inflammatory medicines, or surgery.
An Overview of Dry Eye Syndrome
Episcleritis
Episcleritis refers to inflammation of the episcleral, the clear layer on the top of the white part of the eye called thesclera. This inflammation causes the eyes to appear red and irritated.
Episcleritis is the second most common eye complication of RA and is believed to affect up to 5% of people with the disease.It can occur at any stage of RA, although it is common during times when a person with RA is experiencing high levels of inflammation. In about half of these cases, episcleritis is limited to only one eye.
Episcleritis might resemblepink eye, but it doesn’t cause any discharge. This inflammatory eye symptom tends to clear up on its own without treatment.
There are two types of episcleritis: diffuse and nodular. They appear slightly different from each other. Diffuse type episcleritis affects 70% of people with episcleritis, and nodular episcleritis affects the remaining people with episcleritis.
Both types of episcleritis cause similar symptoms, including:
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Symptoms of episcleritis don’t usually affect vision. Most cases of episcleritis are mild and will resolve with 21 days.Recurrent episodes are treated withrefrigerated artificial tears, mild topical corticosteroid eye drops, or oralnonsteroidal anti-inflammatory drugs(NSAIDs).
For most people, episcleritis is a harmless condition that doesn’t cause any long-term problems. Most of the time, it resolves on its on, and artificial tears help most people with RA manage symptoms.Corticosteroid eye drops and oral NSAIDs are also effective in controlling eye inflammation.
Scleritis
Scleritis is an eye disorder in which thesclerabecomes severely inflamed. The sclera is the white part of the eye and is connected to the muscles that help the eye to move.
Scleritis can be a painful condition that may lead to partial or complete vision loss if not properly treated. This inflammatory eye condition affects up to 6% of people with RA.
There are two main types of scleritis: anterior scleritis, which occurs at the front of the eye, and posterior scleritis, which occurs at the back part of the eye.
The anterior type has three subtypes, with the most common causing redness and irritation to the whole sclera.This type is the most treatable. Another type causes tender nodules (bumps) on the sclera, and the most severe is very painful and may damage the sclera.
The posterior type is much rarer than the anterior type. People with the posterior type have pain and tenderness. This type can lead to detachment of theretina(retinal detachment) andangle-closure glaucoma.The retina is the thin, light-sensitive layer of tissue that lines the back of the eye on the inside.
Most people with RA who have scleritis only have one type, but others might have it on both the front and back of the eye.
Symptoms of scleritis include:
Treatment for scleritis may include:
Scleritis treatment also involves treating its underlying cause. In people with RA, this means effectively managing the condition and getting inflammation under control.
Uveitis
Uveitis is a type of inflammation affecting the middle layer of the tissue in the eyewall (the uvea). It causes eye redness, pain, and blurred vision. It can affect one or both eyes.
Uveitis affects up to 42% of people with RA who have eye involvement.There is some evidence that etanercept, a TNF blocker used in the treatment of RA, may be associated with an increased risk of uveitis in this population.
Uveitis can be serious and lead to permanent vision loss. Early diagnosis and treatment are vital to prevent complications and preserve vision. Symptoms include:
There are four different types of uveitis, based on which parts of the eye are affected:
Treatment for uveitis may include the following.
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How RA Treatment Might Affect Your Eyes
Some of the medicines that treat RA can trigger eye problems. Two medications in particular—corticosteroids and Plaquenil (hydroxychloroquine), an immunosuppressive drug—might affect your eye health.
Corticosteroids
Taking corticosteroids can raise eye pressure, and this is true of many types of steroids, including prednisone.Both eyedrop corticosteroids and oral corticosteroids can lead to eye issues.
Eye pressure increases can occur as early as three to six weeks using eye drops. Corticosteroid injections can cause an increase in eye pressure after several months.
Corticosteroid use has also been linked to steroid-induced glaucoma.While doctors don’t know exactly why this happens, many think steroid medicines stop cells that clear debris in eye cells. This causes a buildup of debris, which increases eye pressure.
Long-term use of corticosteroids is also linked tocataractformation.
If you have RA and take corticosteroids to manage RA and its effects, you should visit your eye doctor regularly. They can check for eye pressure and diagnose any eye problems early.
Plaquenil
Long-term use of Plaquenil has been found to damage the retina, which might lead to serious vision loss.If you experience retina damage, it might take some time to notice vision loss. And, unfortunately, vision loss associated with retina damage is permanent.
If you are taking Plaquenil to treat RA, you should also be seeing an ophthalmologist regularly. This way you can be checked for retina problems before there is any serious damage.
Plaquenil Vision Side Effects: Risks and Prevention
A Word From Verywell
Everyone living with rheumatoid arthritis should see an ophthalmologist yearly. They can diagnose, rule out, or treat any eye problems early on in people with RA. You should also make an appointment with an ophthalmologist if you experience ongoing eye symptoms, including itching, feeling like something is in your eye, eye redness. eye pain, or vision loss.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Akintayo R, Olaosebikan B.THU0127 The severity of keratoconjunctivitis sicca in rheumatoid arthritis correlates with the medical outcome study 36-item short form health survey (SF-36) score but not the disability index (HAQ-DI).Annals of the Rheumatic Diseases2018;77:285. doi:10.1136/annrheumdis-2018-eular.1613Ma W, Wang G, Li X, et al.Study of factors influencing dry eye in rheumatoid arthritis.J Ophthalmol. 2020;2020:5768679. doi:10.1155/2020/5768679Bhamra MS, Gondal I, Amarnani A, et al.Ocular manifestations of rheumatoid arthritis: Implications of recent clinical trials.Int J Clin Res Trials. 2019;4(2):139. doi:10.15344/2456-8007/2019/139Schonberg S, Stokkermans TJ.Episcleritis. StatPearls.Williamson J.A red eye: Scleritis or episcleritis?Review of Optometry.Boyd K.What Is scleritis? American Academy of Ophthalmology.National Eye Institute.Uveitis.Lim LL, Fraunfelder FW, Rosenbaum JT.Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum. 2007 Oct;56(10):3248-52. doi:10.1002/art.22918Feroze KB, Khazaeni L.Steroid induced glaucoma.Kačmar J, Cholevík D.Corticosteroid induced posterior subcapsular cataract.CSO. 2018;74(6):226-232. doi:10.31348/2018/6/2Porter D.What is Plaquenil? American Academy of Ophthalmology.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Akintayo R, Olaosebikan B.THU0127 The severity of keratoconjunctivitis sicca in rheumatoid arthritis correlates with the medical outcome study 36-item short form health survey (SF-36) score but not the disability index (HAQ-DI).Annals of the Rheumatic Diseases2018;77:285. doi:10.1136/annrheumdis-2018-eular.1613Ma W, Wang G, Li X, et al.Study of factors influencing dry eye in rheumatoid arthritis.J Ophthalmol. 2020;2020:5768679. doi:10.1155/2020/5768679Bhamra MS, Gondal I, Amarnani A, et al.Ocular manifestations of rheumatoid arthritis: Implications of recent clinical trials.Int J Clin Res Trials. 2019;4(2):139. doi:10.15344/2456-8007/2019/139Schonberg S, Stokkermans TJ.Episcleritis. StatPearls.Williamson J.A red eye: Scleritis or episcleritis?Review of Optometry.Boyd K.What Is scleritis? American Academy of Ophthalmology.National Eye Institute.Uveitis.Lim LL, Fraunfelder FW, Rosenbaum JT.Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum. 2007 Oct;56(10):3248-52. doi:10.1002/art.22918Feroze KB, Khazaeni L.Steroid induced glaucoma.Kačmar J, Cholevík D.Corticosteroid induced posterior subcapsular cataract.CSO. 2018;74(6):226-232. doi:10.31348/2018/6/2Porter D.What is Plaquenil? American Academy of Ophthalmology.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Akintayo R, Olaosebikan B.THU0127 The severity of keratoconjunctivitis sicca in rheumatoid arthritis correlates with the medical outcome study 36-item short form health survey (SF-36) score but not the disability index (HAQ-DI).Annals of the Rheumatic Diseases2018;77:285. doi:10.1136/annrheumdis-2018-eular.1613Ma W, Wang G, Li X, et al.Study of factors influencing dry eye in rheumatoid arthritis.J Ophthalmol. 2020;2020:5768679. doi:10.1155/2020/5768679Bhamra MS, Gondal I, Amarnani A, et al.Ocular manifestations of rheumatoid arthritis: Implications of recent clinical trials.Int J Clin Res Trials. 2019;4(2):139. doi:10.15344/2456-8007/2019/139Schonberg S, Stokkermans TJ.Episcleritis. StatPearls.Williamson J.A red eye: Scleritis or episcleritis?Review of Optometry.Boyd K.What Is scleritis? American Academy of Ophthalmology.National Eye Institute.Uveitis.Lim LL, Fraunfelder FW, Rosenbaum JT.Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum. 2007 Oct;56(10):3248-52. doi:10.1002/art.22918Feroze KB, Khazaeni L.Steroid induced glaucoma.Kačmar J, Cholevík D.Corticosteroid induced posterior subcapsular cataract.CSO. 2018;74(6):226-232. doi:10.31348/2018/6/2Porter D.What is Plaquenil? American Academy of Ophthalmology.
Akintayo R, Olaosebikan B.THU0127 The severity of keratoconjunctivitis sicca in rheumatoid arthritis correlates with the medical outcome study 36-item short form health survey (SF-36) score but not the disability index (HAQ-DI).Annals of the Rheumatic Diseases2018;77:285. doi:10.1136/annrheumdis-2018-eular.1613
Ma W, Wang G, Li X, et al.Study of factors influencing dry eye in rheumatoid arthritis.J Ophthalmol. 2020;2020:5768679. doi:10.1155/2020/5768679
Bhamra MS, Gondal I, Amarnani A, et al.Ocular manifestations of rheumatoid arthritis: Implications of recent clinical trials.Int J Clin Res Trials. 2019;4(2):139. doi:10.15344/2456-8007/2019/139
Schonberg S, Stokkermans TJ.Episcleritis. StatPearls.
Williamson J.A red eye: Scleritis or episcleritis?Review of Optometry.
Boyd K.What Is scleritis? American Academy of Ophthalmology.
National Eye Institute.Uveitis.
Lim LL, Fraunfelder FW, Rosenbaum JT.Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum. 2007 Oct;56(10):3248-52. doi:10.1002/art.22918
Feroze KB, Khazaeni L.Steroid induced glaucoma.
Kačmar J, Cholevík D.Corticosteroid induced posterior subcapsular cataract.CSO. 2018;74(6):226-232. doi:10.31348/2018/6/2
Porter D.What is Plaquenil? American Academy of Ophthalmology.
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