Editors

MattiSeppänen

Eye Problems in Patients with Rheumatoid Arthritis

Eye problems should be considered when treating patients with rheumatoid arthritis.
- The prevalence of iritis is increased.
- Dry eyes and impaired corneal sensation increase the risk of severe corneal ulceration.
- The prevalence of episcleritis and scleritis is increased.

See Iritis (Inflammation of the Iris).
The possibility of iritis should be kept in mind if a patient with rheumatoid arthritis has a red eye; do not hesitate to refer the patient to an ophthalmologist.
Symptoms
- Eye pain
- Pericorneal redness
- Photophobia
- The pupil may be small and poorly responsive to light, sometimes distorted.
Regular ophthalmological checkups are needed for children with rheumatoid arthritis.
- After diagnosis, every 3-4 months, at first
- Subsequently every 1-2 years, often until the age of 16

See Dry Eye Syndrome.
Symptoms
- Gritty and foreign body sensation
- Redness and itching of the eyes
- Swelling and erythema of the eyelids
- Significant watering of the eyes at times
Treatment
- Frequent use of moisturizing drops
- Ciclosporine drops prescribed by an ophthalmologist
  - To be instilled once daily, often one hour before going to bed.
  - Treatment is often first prescribed for 3 months but often continued for 6-12 months.
  - The drops often cause initial smarting during the first couple of weeks.
  - Check local reimbursement policies, also concerning Sjögren's syndrome Primary Sjögren's Syndrome.
  - The efficacy of the treatment should be assessed every 6 months.

See Corneal Ulcers.
Corneal sensation is often reduced in patients with rheumatoid arthritis. This, together with dry eyes, makes patients susceptible to corneal ulceration.
If treatment is delayed and ulceration has time to progress far, there is a risk of permanent visual impairment.
Symptoms
- Redness of the eye; not necessarily any pain
- In blue light, significant ulceration can be seen on the surface of the eye after fluorescein staining.
Treatment
- Begin with fluoroquinolone drops, 6 times/day.
- Do not hesitate to refer the patient to an ophthalmologist (within 1-2 days).

Seppänen M, Kaarniranta K, Setälä N, Uusitalo H (eds.). [Handbook of ophthalmology]. 3rd, revised edition. Helsinki: Duodecim Publishing Company Ltd, 2022.