Information
Editors
Eye Problems in Patients with Rheumatoid Arthritis
Essentials
- 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.
Iritis
- See Iridocyclitis (Iritis).
- 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
Dry eye syndrome
- 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.
Corneal ulceration
- 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).
References
- Seppänen M, Kaarniranta K, Setälä N, Uusitalo H (eds.). [Handbook of ophthalmology]. 3rd, revised edition. Helsinki: Duodecim Publishing Company Ltd, 2022.