Ocular manifestations of rheumatoid arthritis
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
- Section Editors
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
Rheumatoid arthritis (RA) is a common and chronic systemic inflammatory disease of unknown etiology that primarily involves joints. Extraarticular manifestations are also observed, including ophthalmic involvement. The clinical course of the ocular disease may be quite variable.
The importance of the early diagnosis of ophthalmic disease in the patient with RA cannot be overemphasized, since it permits the timely management of potentially serious sight-threatening complications. The presence of ocular disease may also be an indication of ongoing systemic disease activity [1,2]. However, ocular involvement, in particular severe dry eye, may exist independently from severe articular disease and should be evaluated in all patients with RA regardless of extra-ophthalmic manifestations .
Issues relating to the ocular manifestations of RA are discussed in this review. The anatomy of the relevant structures is depicted in the figure (figure 1). The articular and other nonarticular clinical manifestations of this disorder are discussed separately. (See "Clinical manifestations of rheumatoid arthritis" and "Overview of the systemic and nonarticular manifestations of rheumatoid arthritis".)
INDICATIONS FOR URGENT REFERRAL TO AN OPHTHALMOLOGIST
Urgent referral to on ophthalmologist with expertise in the management of ocular inflammation or corneal-external diseases of the eye should be carried out in patients with rheumatoid arthritis (RA) who present with any of the following:
●Significant change in visual acuity over a period of several days or weeks
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- INDICATIONS FOR URGENT REFERRAL TO AN OPHTHALMOLOGIST
- CORNEAL DISEASE
- Sjögren's and sicca syndromes
- - Clinical features of ocular disease
- - Physical examination
- - Treatment recommendations
- Corneal inflammation and melting
- Corneal infection
- Treatment recommendations
- OTHER OCULAR DISORDERS
- SUMMARY AND RECOMMENDATIONS