Most people with RA do not develop eye problems because of their RA, although approximately 25% of patients with RA will complain of some eye symptoms. The majority of these eye complaints is mild and requires only symptomatic treatment. A very small number of patients develop severe eye inflammation that can affect their vision. These problems require the attention of an eye doctor.
The most common ocular (eye-related) complaint in patients with RA is “dry eyes,” also referred to by the unwieldy medical name keratoconjunctivitis sicca. This condition occurs in as many as 15% of patients and is explained in some depth in Question 20.
A less common, but more serious eye complaint is scleritis. Scleritis is a chronic, painful, and potentially blinding inflammatory disease. Its exact incidence is uncertain, though it is thought to be rare. Some studies indicate that this condition occurs in fewer than 10% of patients with RA and is usually associated with very severe cases of RA. It occurs slightly more frequently in women than men and first occurs in patients who are in their fifties or sixties.
Scleritis is characterized by swelling and redness of the white portion of the eye called the scleral and episcleral tissues. It is sometimes confused with a minor bacterial infection of the eye called “pink eye” (more formally, conjunctivitis) because of the bright red appearance of the eye. Your doctor can tell the difference by taking a thorough history and performing a physical examination.
Conjunctivitis
An inflammation of the outer membrane of the eye.
The most common symptoms of scleritis include pain, tearing, photophobia (pain when the eyes are exposed to bright light), and tenderness when the eye is pressed, and decreased visual acuity. The pain can be severe, so it is often the symptom that prompts someone to seek medical assistance for scleritis. The pain results from stretching of the nerve endings caused by the inflammation.
The initial treatment of scleritis focuses on relieving the eye discomfort and stopping the progression of the disease. This therapy includes common pain relievers that are taken orally (by mouth) such as indomethacin (Indocin) or ibuprofen (Motrin). If a patient doesn't respond to this treatment, he or she should be referred to an ophthalmologist (eye doctor) for stronger medical therapy. This therapy may include steroid eye drops, immunosuppressive medication such as cyclosporine, or an anti-TNF medication such as infliximab (Remicade). If scleritis is not treated, it can result in loss of vision or even the loss of the eye itself, though this occurs only in the most serious and destructive type of scleritis (called necrotizing scleritis).
Other, less common eye-related complications of RA include inflammation of the blood vessels in the eye (choroiditis), retinal detachments, and swelling of the retina (macular edema). All of these complications can result in loss of vision. For this reason, patients with RA should have regular eye exams and speak to their doctor if they experience eye redness, pain, or a change in the acuity of their vision.