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MattiSeppänen

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.