Rheumatoid Arthritis: How Does it Affect Your Eyes?

Rheumatoid arthritis is an autoimmune disease where the immune system mistakenly attacks the body’s tissues, particularly the connective tissues in and around joints.

Eye problems with rheumatoid arthritis are relatively common as parts of the eye are also made up of connective tissue such as the sclera. Common conditions arising from Rheumatoid Arthritis include:

• Dry eye
• Inflammation and pain in the front of the eye
• Episcleritis
• Uveitis
• Scleritis
• Keratitis
• Glaucoma (increased risk due to corticosteroid use)
• Cataracts

In severe cases of inflammation of the eye such as scleritis vision loss may occur. Read on as our experts explain how rheumatoid arthritis can impact the eyes and what to do if you have the symptoms.

Can Rheumatoid Arthritis Affect Your Eyes?

Rheumatoid arthritis (RA) can create several complications involving the eye and its components. The most common problem is dry eye (keratoconjunctivitis sicca) with up to 18% of people with Rheumatoid arthritis reporting this condition.

Rheumatoid Arthritis Eye Symptoms

Dry eye is the most common eye symptom of rheumatoid arthritis.  Patients may have a tear deficiency and often describe a gritty, burning or stinging sensation, along with redness and photophobia.

Scleritis, inflammation of the white part of the eye can be sight-threatening and, typically causes deep aching pain, redness, and blurred vision.

Episcleritis is an inflammatory condition affecting the episclera, which is a thin layer of tissue between the conjunctiva and the sclera (the white part of the eye). Other symptoms may include eye discomfort, redness in one or both eyes, and light sensitivity (photophobia).

Uveitis, an inflammation of the middle layer of the eye, can also lead to eye pain or discomfort, redness (particularly around the iris (coloured part of the eye), photophobia, and blurred vision.

Less common but serious symptoms include peripheral ulcerative keratitis (PUK), inflammation of the cornea, which causes severe pain, tearing and, if untreated, corneal thinning leading to visual loss.

A rare but potentially serious complication is retinal vasculitis, which is inflammation of the blood vessels in the retina and may lead to vision loss if untreated.

Patients should be aware of vision changes, sudden onset of eye pain or severe redness, as these could be a sign of more severe eye involvement and could mean that medical help is needed immediately.

Diagnosing Rheumatoid Arthritis-Related Eye Conditions

To diagnose rheumatoid arthritis, doctors typically do a combination of medical history, physical exams and lab tests. Your doctor will likely ask about your symptoms, such as joint pain, stiffness and swelling. Blood tests are also typically done to look for markers of inflammation like elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). (Elevated CRP or ESR are both markers of inflammation that can be found in the blood of many patients with RA.) Blood tests can also look for certain antibodies called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP); these antibodies are found in most patients with the disease.

Occasionally, the doctor might order imaging tests such as X-rays, ultrasounds or CT scans. These tests are used to see potential damage to the joints or inflammation that is not visible on physical exam. An ultrasound or MRI might be used to detect rheumatoid arthritis in the joints when the disease is still early. A CT scan is useful in advanced cases to examine joint or bone damage. These imaging tools are important in seeing what is happening to the joints and guiding treatment.

When to Contact a Medical Professional

You should consult your doctor if you suspect you have rheumatoid arthritis, and your symptoms persist for more than a few weeks. This includes joint pain, stiffness (especially in the morning or after periods of inactivity), swelling, or warmth of the joints. Early diagnosis and treatment are key to controlling the disease and slowing the progression of joint damage.

We recommend seeing a doctor immediately if symptoms are felt in multiple joints, on both sides of the body or are accompanied by malaise, fever or weight loss.

Similarly, if eye symptoms such as redness, discomfort or pain and blurred vision begin to set in, it’s imperative to get care right away from your optometrist or nearest eye hospital as these might signify rheumatoid arthritis-related eye diseases that could progress to serious outcomes if left untreated.

Treatment Options to Consider

The treatment of rheumatoid arthritis aims to reduce inflammation, relieve symptoms and prevent joint damage. The usual treatments are:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): They may reduce inflammation and relieve pain but do not slow the disease process.
• Corticosteroids: Prednisone and other corticosteroids have a rapid anti-inflammatory and pain-reducing effect, particularly in episodes of flare. Because long-term use of corticosteroids can lead to serious side effects, including glaucoma and cataracts, those on prolonged corticosteroid therapy should get a regular eye check.
• Disease-Modifying Antirheumatic Drugs (DMARDs): Rheumatologists prescribe methotrexate and other DMARDs, which slow disease progression by affecting the immune system to reduce joint damage over time. Biologics, the newest class of DMARDs, interfere with parts of the immune system and are often prescribed to people with moderate to severe RA.
• Physical Therapy: Maintaining range of motion, strength, and mobility, as well as reducing pain, is an important goal of physical therapy.

How Do You Treat Dry Eyes with Rheumatoid Arthritis?

For patients with RA who suffer from dry eyes, a wide selection of treatment options can help control symptoms. The best eye drops for rheumatoid arthritis are artificial tears or lubricating eye drops to relieve dryness and discomfort. Preservative-free lubricating drops, available over the counter, are often recommended for use as and when needed, as they can reduce irritation with fewer side effects compared to preservative lubricating drops.