Rheumatoid Arthritis and Eye Concerns

Adapted from a Public and Patient Education Program presentation at HSS


Sergio Schwartzman, MD

Sergio Schwartzman, MD

Associate Attending Physician, Hospital for Special Surgery
Associate Professor, Weill Cornell Medical College
Clinical Director, Inflammatory Arthritis Center of Excellence

Many medicines prescribed to treat rheumatoid arthritis have side effects. How does one go about choosing the proper medication for their specific needs?

With all medications, you need to be aware of the side effects that may come along with the medicationís benefits. When looking at a specific medication, you must weigh the risks of side effects with the predicted benefits. Since it is very important to treat inflammatory eye disease, medication is usually not avoided unless the risk of unwanted side effect is very high or the problem is not very serious. Before starting or stopping any medications, please make sure to check with your physician.

What is the correlation between rheumatoid arthritis and the eyes?

Rheumatoid arthritis is commonly characterized by the inflammation and swelling of joints, systemic symptoms, and pain. Some patients with rheumatoid arthritis may develop dry eye syndrome, scleritis, or uveitis, although these conditions are rare.

What kind of doctor should I go see if I am suffering from eye problems?

Most go immediately to see an ophthalmologist. In actuality, you should see an ophthalmologist and a rheumatologist, who will communicate with one another.

An ophthalmologist is the doctor who will assess and diagnose your eye condition. The rheumatologist is expert in using medications in those patients with significant eye inflammation. 

What is dry eye syndrome? What are the causes and treatments for it?

Dry eye syndrome is a decrease in tear production typically due to abnormalities in the immune system. Symptoms include a burning sensation or a foreign body sensation in the eye. For example, people with dry eye syndrome often complain of feeling as if they have sand in their eyes.

Signs of dry eye are diminished tear production, delayed tear breakup time, excess mucus, debris on the eye, and an inflamed/red eye. A Schirmerís test is used to detect dry eye by testing how much moisture is produced by the eye in in a given time.

Medicines such as diuretics, antihistamines, and contraceptives can cause or worsen dry eye syndrome. Medications such as artificial tears, lubricating ointments, lacrimal duct occlusion, and an artificial tear insert can be used to treat dry eye syndrome.

How can conjunctivitis be distinguished from scleritis?

While they both include a profound redness of the white area in the eye, conjunctivitis causes redness and swelling in other areas of the eye as well.

What is Restasis®  ophthalmic emulsion? What are the side effects?

Restasis® is a medication recently approved for dry eye syndrome. It is an eye drop with a medication called cyclosporine. Cyclosporine is an immunosuppressant that affects T-cells and is used by applying one drop in the eye two times a day.

Restasis® is not to be used by those who have had an allergic reaction to cyclosporine, prior adverse reaction to Restasis® drops, or those with infections of the eye.

Restasis® may create an allergic reaction in the eye if an infection is present or the person is prone to infections. It may lower a personís resistance, making them more prone to further infections. Restasis® is one of the safer medications, and is the first immunosuppressant on the market in the form of drops.

What is a stye?

It is an infection in the eye that appears as a swollen bump. A person with a stye can be treated as an outpatient with antibiotics and soap.

If it gets severe, however, it can become orbital cellulitis. This appears as an extensive swelling around the eye, often resulting in forced closure of the eye. When orbital cellulitis gets this bad, it can lead to significant visual loss. Both styes and orbital cellulitis can occur in people with or without rheumatoid arthritis.

What is Uveitis?

It is an inflammation of the uveal tract around the iris of the eye. The uveal tract is responsible for supplying blood to the eye, adjusting the pupil size, and forming the aqueous and vitreous fluid. It affects approximately 15 out of every 100,000 people, and about 33% of chronic uveitic eyes (symptoms lasting more than three months) become blind.

There are different types of uveitis, including anterior uveitis, posterior uveitis, pan-uveitis and intermediate uveitis. Anterior uveitis is an inflammation that primarily involves the anterior chamber. Posterior uveitis is an inflammation that primarily involves the choroid and/or retina. Intermediate uveitis is an inflammation that primarily involves the vitreous. Pan-uveitis is an inflammation that involves both the anterior and posterior segments, and it is the most severe type of uveitis.

Adapted by the Education Division at HSS

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