Rheumatoid arthritis (RA) is an autoimmune condition that affects the joints, but it can also affect the lungs, skin, and eyes. People with RA may experience dryness, irritation, or grittiness in the eyes.

RA occurs when the immune system mistakenly attacks healthy tissues in the body. It mainly attacks the connective tissues of joints, which contain collagen.

Some parts of the eye, such as the white of the eye, or sclera, and the clear structure at the front of the eye, or cornea, also contain collagen. Sometimes, RA affects these tissues as well. Some medications doctors use to treat RA can also contribute to eye conditions.

In this article, we will look at how RA affects the eyes, what symptoms and conditions it may cause, and how doctors treat them.

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Eye problems are common in people with RA. A 2021 review of 3,394 studies found that around 1 in 5 people with RA have problems with their eyes.

Individuals with RA may experience the following symptoms in their eyes:

Below are some of the eye conditions that RA may cause or that it is associated with.

Dry eye syndrome

Dry eyes are a common symptom, affecting 15% of the general population. However, it is much more common in people with RA. A 2019 review notes that in some studies, up to 90% of individuals with RA reported having dry eyes.

Dry eyes may result in:

  • irritation
  • grittiness
  • burning or itching
  • a pulling or pressing sensation in the eyes
  • discomfort or pain
  • sensitivity to light

Sometimes, people with RA also have Sjögren’s disease. This condition causes white blood cells to attack glands that secrete fluid, including the tear glands. This results in dry eyes.

Scleritis

Scleritis occurs when the sclera becomes inflamed.

According to the American Academy of Ophthalmology, it is common for people with scleritis to have another condition, such as RA. RA is the cause of 8–15% of scleritis cases. Experts also link scleritis to Sjögren’s disease.

Symptoms of scleritis include:

  • pain and tenderness in the eye
  • redness and swelling of the white part
  • blurred vision
  • excessive tearing
  • sensitivity to light

Some individuals may also experience pain or tenderness in other parts of the face or head, and others may lose all or part of their vision.

Scleritis requires prompt treatment from an ophthalmologist. This is especially true for people with RA and other autoimmune conditions, as they are more likely to experience necrotizing scleritis, which is the most severe form.

Episcleritis is more common and less painful than scleritis. It affects the tissue in front of the sclera and can also cause a sore, red eye. It usually goes away without treatment.

Keratitis

Keratitis is inflammation of the cornea, the clear dome at the front of the eye.

Symptoms of keratitis include:

  • pain or irritation in the eye
  • redness
  • problems with vision
  • a feeling that something is in the eye
  • excessive tearing or discharge
  • difficulty opening the eyelids
  • sensitivity to light

This condition needs prompt treatment, as it can lead to serious complications that may permanently damage vision.

Keratitis sometimes leads to scarring on the cornea or a thinning at the center or edges of the cornea. This can co-occur with dry eyes or scleritis.

Uveitis

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Uveitis is inflammation of the uvea, the middle part of the eye. It can cause three types of inflammation:

  • anterior uveitis, which is inflammation in the front portion of the uvea
  • intermediate uveitis, which is swelling in the middle of the uvea
  • posterior uveitis, which is swelling toward the back of the uvea

In severe cases of uveitis, swelling may affect all parts of the uvea. Health experts refer to this as panuveitis.

Symptoms of uveitis can include:

  • red eye, with or without pain
  • sensitivity to bright light
  • blurred vision
  • sudden floaters in the eye

Uveitis requires prompt treatment to prevent long-term complications.

Drug side effects

Some medications that doctors use to manage RA can trigger eye problems. For example, experts associate the use of corticosteroids with an increased risk of glaucoma and cataracts.

Glaucoma develops when there is an increased pressure inside the eye, damaging the optic nerve. Cataracts occur when the lens of the eye becomes cloudy, decreasing a person’s vision.

Hydroxychloroquine can also have adverse effects on the eye, harming the cornea, retina, or ciliary body, which is a structure behind the iris that produces the fluid that fills the eye.

If a person suspects that medication could be causing eye symptoms, they should consult a doctor about changing the dose or type of drug they are taking. They should not change medication without medical supervision.

In order to diagnose an eye condition, an ophthalmologist will ask a person about their symptoms and medical history. They will then perform an examination of the eyes using a microscope called a slit lamp.

For inflammation toward the back of the eye, a doctor may recommend a CT or an ultrasound scan.

Treatment for RA-related eye symptoms depends on their cause and severity.

To address dryness that occurs due to RA or Sjögren’s disease, doctors may suggest:

  • artificial tears
  • immunosuppressant eye drops
  • tear duct plugs
  • disposable eye inserts that slowly release artificial tears to relieve dryness
  • autologous blood serum drops, to mimic the vitamins and other growth factors present in tears

For conditions such as scleritis, treatment depends on the severity of the inflammation.

Initial treatment for mild pain and inflammation may include:

  • anti-inflammatory eye drops
  • short-term oral corticosteroids
  • medication changes to manage RA more effectively

More severe inflammation may require a person to seek help from a rheumatologist to adjust how they manage their RA. The rheumatologist may suggest immunosuppressants to decrease the immune system’s activity and reduce the risk of permanent eye damage.

If RA-related conditions such as uveitis, keratitis, or scleritis do not receive prompt treatment, they can lead to vision loss. This is why it is essential for people to seek medical help as soon as possible if eye symptoms arise.

Contacting an ophthalmologist regularly during treatment for RA can also help identify any adverse effects of medication early.

People with RA should have regular eye checkups with an ophthalmologist. They should also visit this eye specialist promptly if they have any eye problems, including:

  • redness
  • pain
  • problems with vision
  • itching or irritation

If an individual experiences severe or sudden pain, partial or total loss of vision, or sensitivity to light, they should seek immediate medical attention.

People with RA can experience eye symptoms either because of the autoimmune condition itself or because of the medication they take to manage their RA. A person may develop dryness, irritation, or redness in the eye.

Sometimes, conditions such as keratitis, uveitis, or scleritis develop in people with RA. These conditions need prompt treatment in order to reduce inflammation and prevent damage to the eye.

Having regular checkups with an ophthalmologist can help monitor for early signs of eye conditions in those with RA. If new symptoms develop, however, a person should contact a doctor as soon as possible.