Rheumatoid arthritis (RA) is an autoimmune disease that causes painful swelling in the body’s tissues. RA usually affects the joints, because their connective tissue becomes inflamed. Our eyes are made up of this same collagen-rich tissue, which can make them a target for inflammation.

Common eye problems related to rheumatoid arthritis include dryness and inflammation. Over time, it’s possible for more serious eye conditions, such as cataracts and glaucoma to occur.

Autoimmune disorders, including rheumatoid arthritis, are caused by a glitch in the body’s immune system. The immune system is meant to fight off infection to keep us healthy or to help us heal.

In autoimmune diseases, the immune system also fights the healthy cells by mistake. This often leads to redness, pain and swelling in the area being “attacked” by the immune system. 

RA targets connective tissue, which is made up largely of a protein called collagen. Collagen is also the main component that makes up the cornea and sclera of the eye. The presence of these tissues, among many others in and around the eyes, allow RA symptoms to appear in the eyes.

Dryness is the most common symptom experienced by people with RA. The glands responsible for keeping the eye moist — the lacrimal and meibomian glands — are damaged by the immune system. This causes a condition called secondary Sjogren’s syndrome, which is often related to RA. However, it’s possible for Sjogren’s syndrome to occur alone (primary).

Eye inflammation is another common ocular symptom of RA. The immune system attacks the collagen-rich tissues within the eye. This can cause the tissues to become irritated and inflamed. 

Rheumatoid arthritis can cause many eye issues. Though they vary in severity, most of them can be managed or prevented with proper treatment.

Dry eye syndrome

Dry eye syndrome is a condition in which there is a chronic lack of moisture on the eye’s surface. Inflammation caused by rheumatoid arthritis damages the oil glands that lubricate the eyes.

Dry eye syndrome is found in other autoimmune diseases, such as Sjogren’s syndrome and lupus.

People with dry eye syndrome often experience the following symptoms:

• Burning
• Redness
• Itchiness
• Light sensitivity (photophobia)
• Foreign body sensation (feeling like there is something in your eye)
• Difficulty or discomfort wearing contact lenses

Uveitis

The uvea is the middle layer of the eye, and is made up of the choroid, ciliary body and iris. Each of these parts plays a critical role in the eye’s ability to see. In cases in which RA starts to affect the uvea, one or more of these parts can become inflamed — a condition called uveitis.

Anterior uveitis characterizes inflammation of the iris and/or the ciliary body. Intermediate uveitis means only the ciliary body is inflamed. When the choroid is inflamed, it’s known as posterior uveitis. Diffuse uveitis or panuveitis are terms used when all parts of the uvea are inflamed.

Symptoms associated with uveitis include:

• Photophobia
• Redness
• Pain
• Blurry vision

Scleritis

The sclera, also known as the whites of your eyes, work as the walls of the eyeball. They give the eyeball its shape and protect everything inside of it. 

RA can target the woven, web-like tissues that make up the sclera. Inflammation of these tissues is called scleritis. Scleritis can occur in the front part of the sclera (anterior scleritis) or in the back part (posterior scleritis).

There are different ways rheumatoid arthritis can affect the sclera. Inflammation across the scleral surface is the most common type of scleritis. Though rare, it’s also possible for raised nodules to form in areas of the sclera, or for scleral tissue to erode.  

People with scleritis usually experience:

• Sharp, severe eye pain that develops over several days
• Light sensitivity
• Blurred vision
• Redness
• Swelling
• Excessive tearing

Keratitis

Keratitis describes inflammation of the cornea (the clear surface across the front of the eye). There are many different types and causes of keratitis. Ulcerative keratitis or peripheral ulcerative keratitis is the type associated with RA.

Peripheral ulcerative keratitis (PUK) is a condition in which inflammation deteriorates the cornea. The deterioration process is known as corneal melting. 

Inflammatory damage usually appears as a crescent shape in the limbus area of the cornea. The limbus region borders the cornea and the sclera. The outer edges of the iris (colored part of the eye) work as a marker for where the limbus is located.

Symptoms of peripheral ulcerative keratitis include:

• Foreign body sensation
• Light sensitivity
• Blurry vision
• Eye pain
• Excessive tearing

RA can also lead to more serious, long-term eye conditions. These conditions can include:

Cataracts

Cataracts occur when the clear, natural lens of the eye becomes cloudy and opaque. It’s very common for people to develop cataracts as they get older. However, people with RA are more susceptible to getting cataracts at a younger age.

Inflammation in the eye can cause premature cataracts to develop. Prolonged steroid use can also contribute to early cataract development.

If untreated, cataracts can lead to vision loss. Fortunately, cataracts can be treated with cataract surgery.

Symptoms associated with cataracts include:

• Seeing glare and/or halos around lights
• Light sensitivity
• Difficulty seeing in low light conditions
• Vision appears hazy or dim
• Dull, diminished color vision

Glaucoma

Glaucoma is characterized by high pressure within the eye. Over time, the high eye pressure can put pressure on and harm the optic nerve at the back of the eye. 

The optic nerve is a critical part of our eyesight, so damage to it can be sight-threatening.

Tissues within the eye that help drain fluid — called the trabecular meshwork — become inflamed and damaged due to RA. When this happens, eye fluid is not able to drain properly and pressure within the eye begins to rise.

Glaucoma is also a side effect of long-term corticosteroid use, which is a treatment option for RA. Potential side effects and how they may affect an underlying condition should be discussed with your doctor.

While early stages of glaucoma don’t usually present symptoms, those who have it may experience:

• Headaches
• Eye pain
• Blurred vision
• Nausea and vomiting
• Blind spots in vision

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Each eye problem related to RA has its own treatment. However, the best way to reduce rheumatoid arthritis eye issues is by managing your RA.

Pharmacological and natural RA treatment can keep inflammation at bay and spare your eyes from its effects.

Pharmacological treatment:

• Non-steroidal anti-inflammatory agents (NSAIDs)

• Corticosteroids

• Disease modifying anti-rheumatic drugs (DMARDs)

• COX-2 inhibitors

At-home therapies:

• Resting during flare ups

• Applying heat or cold to affected area

• Eating nutritional foods that avoid or reduce inflammation

• Getting regular exercise that increases range of motion, strength and endurance

• Physical and occupational therapy