Can rheumatoid arthritis affect the eyes and vision?  Just as RA is an inflammatory disease which attacks bones and joints, it can also attack the eyes.  Complications may include dry eyes, episcleritis, scleritis, corneal problems, glaucoma, cataracts, and Sjogren’s Syndrome.  As patients living with complicated medical issues, we should get regular check-ups including annual eye exams.

Dry Eyes, Sjögren's Syndrome, and RA

Dry eyes is a common problem for patients living with rheumatoid arthritis.  Patients may notice irritation, a gritty feeling, painful burning, sensitivity to light, and a sensation that something is in the eye.  It is caused by a lack of tear production.  Patients with dry eyes are at increased risk for infections around the eye and damage to the cornea.

Eye dryness is also a symptom of Sjögren's syndrome which is an inflammatory disease that can affect many different parts of the body, but most often affects the tear and saliva glands.  Approximately 10 to 25 percent of rheumatoid arthritis patients will develop Sjögren's syndrome.  Treatment for dry eyes include artificial tears or prescription eye drops (ie. Restasis).

Scleritis and Episcleritis

Looking at the eye, we can easily identify the pupil, iris (the color parted), the sclera (the white part), and the cornea (the clear covering).  The sclera can become inflamed causing the white of the eye to become red.  The inflammation causes pain and sensitivity to light. Scleritis is a serious and painful disease which can create a hole in the eyeball if left untreated.  Scleritis is treated with prescription anti-inflammatory medication, usually prednisone eye drops.

The thin membrane which covers the sclera is the episclera.  Inflammation of this thin lining can also cause red eyes, pain, and irritation.  While episcleritis is not as serious as scleritis, it is also treated with anti-inflammatory drugs and corticosteroid eye drops.  If left untreated, episcleritis can become painful and create an environment which is more vulnerable to infection.

[I recently experienced a case of episcleritis caused by a cold virus sneaking into my eyes.  The irritation and swelling became painful so I consulted my eye doctor who prescribed eye drops featuring a mild antibiotic and corticosteroid.]

The Cornea

The cornea can become inflamed (often from scleritis) which will dramatically reduce visual acuity.  A potential complication of inflammation and dry eyes is corneal infection or conjunctivitis.  A rare but serious complication of rheumatoid arthritis is corneal melt.  It often signals the development of systemic vasculitis in RA patients.  Corneal melt must receive early and aggressive treatment.

Please consult your ophthalmologist whenever you experience new symptoms related to the eyes.  Remember to get annual eye exams also.