Can Rheumatoid Arthritis Cause Eye Problems?

When rheumatoid arthritis (RA) targets the eye, it attacks the collagen in the sclera (white of the eye) and cornea (clear outer layer on the front of the eye). This effect causes several symptoms that affect vision.

Over 25% of U.S. adults develop rheumatoid arthritis, with about 27% of RA cases affecting the eyes. It tends to affect women more than men.^1,2 With early detection and treatment, symptoms of arthritis can diminish.

RA is the most common type of arthritis that affects the eyes. Other forms of the disease that can target vision include:

• Psoriatic arthritis
• Ankylosing spondylitis
• Juvenile idiopathic arthritis

Fibromyalgia isn’t a form of arthritis but another condition with similar symptoms affecting vision.

Can Rheumatoid Arthritis Cause Eye Problems?

Rheumatoid arthritis (RA) is an autoimmune disorder where the immune system mistakenly attacks healthy connective tissue in the lining of the joints. It commonly occurs in the hands and knees but can affect the lungs, heart, and eyes.

Rheumatoid arthritis can affect the eyes by targeting the collagen in the sclera and cornea, resulting in eye inflammation and other effects.

Other eye problems from RA include:

• Blurred vision
• Pain
• Dry eyes

When RA spreads to the eyes, the inflammation can cause several eye complications, including:

• Dry eye syndrome. Insufficient tear production and maintenance
• Scleritis. Inflammation of the sclera 
• Uveitis. Inflammation of the vascular layer of the eye (uvea)
• Retinal vascular occlusion. Blockage of blood vessels feeding the retina
• Glaucoma. High pressure in the eye that damages the optic nerve
• Cataracts. The clouding of the eye lens caused by inflammation 
• Peripheral ulcerative keratitis. Inflammation and ulceration of the cornea

Symptoms of Rheumatoid Arthritis In the Eyes

If you have RA and experience changes in vision or eye pain, you should consult your doctor to see if the inflammation has spread to your eyes.

The most common symptoms of arthritis in the eyes are:

• Dry eye
• Light sensitivity
• Pain
• Swelling
• Blurred vision
• Redness

Diabetes is a common comorbidity for people with RA. That means these people are often affected by these conditions simultaneously.

Diabetes makes a person prone to diabetic retinopathy. This dangerous eye condition can cause vision loss and blindness.⁴

Severe Symptoms of Rheumatoid Arthritis In the Eyes

If left untreated, eye arthritis can cause severe symptoms that may cause irreversible damage to your eyesight and possible blindness. 

Seek immediate medical attention if you experience the following:

• Severe pain
• Vision loss 
• Reduced vision 
• Increased eye pressure
• Cloudy vision 
• Halos around lights
• Light sensitivity
• Blurred vision

How is Eye Arthritis Diagnosed?

Comprehensive eye exams can catch ocular manifestations of RA in their early stage. You should get routine comprehensive eye exams by an eye specialist, especially if you have any arthritis that can affect the eyes.

An ophthalmologist will ask you about your medical and family history. Other things you can expect from a comprehensive test include:

• Inspection for cloudy lens
• Measurement of the quality and thickness of your tears
• Check for inflammation of the sclera and cornea
• Measurement of intraocular pressure

If the ophthalmologist suspects uveitis, they will need additional tests as this condition can indicate an underlying medical condition.

These tests can include:

• X-rays
• Skin tests
• Blood tests

Can an Eye Test Detect Arthritis?

An eye test can help determine if you have arthritis. Your doctor may order additional tests if you are experiencing dry eyes or have frequent inflammation. 

During the eye exam, they will look for redness accompanied by deep, severe pain. These symptoms can occur due to scleritis, a complication caused by RA.

Can a Blood Test Detect Rheumatoid Arthritis?

While there isn’t a blood test that can determine if you have RA, specific blood tests can indicate the presence of inflammation associated with RA.

These blood tests include:

• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP) 
• Complete blood count (CBC)
• Rheumatoid factor (RF)

A CBC blood test can identify anemia, a common RA symptom. Elevated ESR and CRP levels indicate inflammation, a hallmark sign of RA.  

Eye Arthritis Treatment

Eye arthritis is typically treated with medication, depending on symptoms and complications.

These are the possible treatments for RA:

• Artificial tears. Treats dry eyes
• Punctal plugs. Blocks the tear ducts using silicone or gel plugs; treats severe cases of dry eyes
• Corticosteroid eye drops or pills. Treats severe eye inflammation; can be combined with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin
• Antibiotics or antiviral medications. For suspected infections
• Surgery. For arthritis complications like glaucoma or cataracts

While steroid medication is an excellent treatment to reduce swelling quickly, long-term use of corticosteroids can cause or worsen cataracts and glaucoma.

Plaquenil (hydroxychloroquine), often prescribed for people with RA, has been linked to retinopathy (dangerous retinal toxicity) and can lead to vision loss.⁷

Is Eye Arthritis Curable?

There is no cure for arthritis. However, you can manage the condition with medication and lifestyle changes.

The best way to control eye arthritis is first to control systemic RA and reduce flare-ups. Symptoms of arthritis in the eyes can be treated and managed with medication, depending on what part of your eye is affected.

Risk Factors of Rheumatoid Arthritis

RA has several risk factors. The biggest culprit of RA is inflammation (swelling), causing stiffness and severe joint pain.

Other risk factors include:

• Genetics
• Age
• Sex
• Smoking
• Gender
• Obesity

Preventing Eye Problems Associated with Rheumatoid Arthritis

The best way to maintain eye health and prevent issues associated with RA is first to control systemic symptoms. Routine eye exams and consults with your eye doctor are important if you are experiencing pain or vision changes. Doing these can help combat eye arthritis before it becomes severe.

The most effective ways to improve your quality of life if you are living with RA include:³

• Exercise 30 minutes a day
• Take an RA-specific exercise class
• Join a support class to learn from other people with RA
• Stop smoking
• Eat a healthy diet
• Maintain a healthy weight

Summary

Rheumatoid arthritis can cause eye complications such as dry eyes, scleritis, uveitis, glaucoma, and cataracts. Since RA is an autoimmune disease, it can attack the collagen in the sclera and cornea, causing severe inflammation. 

The best way to prevent eye arthritis is first to control systemic RA. Medications like steroid eye drops and anti-inflammatories can help reduce eye symptoms. If you experience eye pain or vision changes, it is essential to immediately consult an eye specialist to treat the underlying condition early and prevent complications to your vision.