Rheumatoid arthritis, an autoimmune disease, not only affects the joints; it also can affect the eyes, too. Learn why and get tips for managing eye problems.

Rheumatoid arthritis is primarily thought of as a joint disease, but, in fact, rheumatoid arthritis often causes eye complications. Parts of the eye can become inflamed, causing pain and even some loss of vision.

“Rheumatoid arthritis does not only involve joints, but also several other organs. The eye lining is one of these,” says Uzma Haque, MD, assistant professor of medicine, division of rheumatology, Johns Hopkins University.

Rheumatoid Arthritis: Dry Eyes

Haque says that dry eyes is the most common eye problem that people with rheumatoid arthritis face. This complication can be mild or severe. Patients say their eyes feel dry or as if something is in them, “like some grit or irritant in the eye that you can’t get rid of,” Haque says.

Signs of dry eyes include:

• Your tear ducts aren’t producing many tears
• You have lots of mucus
• You are cleaning up eye debris
• You have an inflamed eye

Treatment for dry eyes is often with artificial tears, Haque says. A rheumatologist or family physician can prescribe these. For people whose dry eyes don’t clear up with artificial tears, there are other drugs that only an ophthalmologist, an eye specialist, can prescribe. “Clyclosporine [Restasis] eye drops can improve severe dry eyes,” Haque says.

Drugs that can make dry eye symptoms worse include contraceptives, diuretics, and antihistamines.

Rheumatoid Arthritis: Scleritis

The thin lining of the sclera, or the white of the eye, can get inflamed. Scleritis causes the eye to turn red and to tear up, Haque explains. “Inflammation makes your eyes angry-looking. You may also feel pain in the eye, and be intolerant to light.”

The pain could be severe. And if it’s not taken care of, scleritis could create a hole in the eyeball.

If you have active scleritis, your rheumatologist will refer you to an ophthalmologist, who will prescribe anti-inflammatory drugs, usually prednisone eye drops, Haque says. Prednisone is a corticosteroid.

Rheumatoid Arthritis: Iritis and Uveitis

The iris is the colored part of your eye that helps control how much light enters the eye; the uvea, the middle lining of the eye, supplies the eye with most of its blood. In uveitis, the uvea becomes inflamed; and in iritis, a form of uveitis, the iris becomes inflamed. Iritis and uveitis are less common, Haque says, but they can be associated with rheumatoid arthritis.

Symptoms include eye pain, spotty or blurred vision, and light intolerance. These conditions can be treated with medicated eye drops. And dark glasses can help with light sensitivity.

However, one form of uveitis, called posterior uveitis, could cause permanent vision loss. Other complications from uveitis include glaucoma and cataracts.

Rheumatoid Arthritis: Medication Complications

Some medications used to treat rheumatoid arthritis may cause eye-related complications. People on these medications can take some preventive steps to minimize risks.

One such drug is prednisone. “Taking prednisone by mouth is associated with glaucoma,” Haque says. Although prednisone is not the standard of care, Haque estimates that about a quarter of RA patients may take prednisone. “This is not the case for people with mild disease, but when the rheumatoid arthritis is harder to control.”

“Chronic prednisone users should get their eyes pressure tested once a year,” Haque says. The pressure test for glaucoma is a standard procedure and can be done at any optometrist’s office.

Another drug that could potentially cause eye problems is hydroxychloroquine (Plaquenil). While rare, the drug has been associated with damage to the retina, the part of the eye that converts light coming into the eye and sends signals to the brain allowing you to see. If your doctor starts you on hydroxychloroquine, you will need to periodically visit an eye doctor to look for the early signs of damage to the retina.

Rheumatoid Arthritis: When to See an Ophthalmologist

Haque says there are three main reasons that you would get an ophthalmology referral: if you’re having eye symptoms, if you’re taking certain medications that cause eye complications, or if your dry eyes become so significant that artificial tears aren’t helpful.

Make sure to schedule an appointment with an ophthalmologist at the first sign of eye trouble — an early diagnosis can prevent long-term damage.