Rheumatoid Arthritis and Your Eyes: Complications and More

Rheumatoid arthritis (RA) is famous for picking fights with jointshands, wrists, knees, the whole greatest-hits album.
But RA is also a whole-body inflammatory condition, which means it can wander off and bother other tissues, including
the eyes. And while your eyes did not RSVP to the autoimmune party, they can still end up doing cleanup.

The good news: many RA-related eye problems are treatableespecially when caught early. The tricky part is knowing
which symptoms are “annoying but manageable” (hello, dry eye) and which are “call an eye doctor today” (hello,
deep eye pain and light sensitivity). Let’s break it down in plain English, with practical examples and no scary
mystery jargon.

How Rheumatoid Arthritis Can Affect the Eyes

RA can impact eye health in a few different ways:

• Inflammation from the disease itself can involve the outer white coat of the eye (sclera), the layer on top of that (episclera), the cornea, or internal eye structures.
• Secondary Sjögren’s disease (an autoimmune condition that often overlaps with RA) can reduce tear production, causing dry, irritated eyes.
• Blood vessel inflammation (vasculitis) in severe cases may contribute to serious eye complications.
• Medication effectssome RA treatments protect vision by controlling inflammation, but a few can affect the eyes and require monitoring.

Think of it like this: sometimes RA affects the eye directly, sometimes it brings a “plus one” (like Sjögren’s),
and sometimes the treatment plan needs a little extra eye-related supervision.

The Most Common RA-Related Eye Complications

1) Dry Eye (Keratoconjunctivitis Sicca): The #1 Troublemaker

If you have RA and your eyes feel gritty, burning, tired, or like there’s a rogue eyelash in there (when there
isn’t), dry eye is often the culprit. Dry eye can happen from inflammation affecting tear glands and oil glands,
and it’s especially common when RA overlaps with secondary Sjögren’s disease.

Common dry eye clues:

• Stinging, burning, or “sand in the eyes” feeling
• Blurred vision that comes and goes (often improves after blinking)
• Watery eyes (yescounterintuitive, but irritation can trigger reflex tearing)
• Light sensitivity, especially in dry air or with screen time
• Redness that’s worse late in the day

Why it matters: severe dry eye isn’t just uncomfortable. Over time it can irritate the cornea
(the clear front “window” of the eye), raising the risk of infections or surface damage.

Example: A customer support rep with RA notices their eyes feel “scratchy” by noon and their
contacts are suddenly unbearable. They assume it’s just too much screen time. It might bebut if RA-related dry
eye is in the mix, they often improve dramatically with a targeted plan (better lubricating drops, treating
eyelid oil glands, and sometimes prescription anti-inflammatory eye drops).

2) Episcleritis: Red Eye, Usually Mild

Episcleritis is inflammation of the episclera, a thin layer over the sclera. It often causes localized redness
and mild discomfort. It can look dramatic in the mirror, but it’s usually less painful than deeper inflammation.

Typical features: irritation, tenderness, and rednessoften without major light sensitivity or deep pain.
Episodes may come and go, sometimes flaring with systemic inflammation.

Even if episcleritis can be mild, it’s still worth getting checkedespecially if you have RAbecause “red eye”
is a crowded category and you want the right label (and the right treatment).

3) Scleritis: The One You Don’t “Wait Out”

Scleritis is inflammation of the sclera (the tough white coat of the eye). It’s more serious than episcleritis
and can threaten vision if untreated.

Classic scleritis symptoms:

• Deep, intense eye pain (often worse with eye movement)
• Redness that may look deeper or more diffuse
• Light sensitivity and tearing
• Blurred vision or a feeling that the eye is “tender inside”

Scleritis is often linked to systemic autoimmune disease activity. Treatment commonly involves coordinating
ophthalmology and rheumatology carebecause controlling the underlying inflammation is key.

Example: Someone with stable RA wakes up with one eye that feels like it “has a toothache.”
That deep acheespecially with redness and light sensitivityis a reason to seek prompt evaluation, not to
“sleep on it and see.”

4) Uveitis: Less Common in Adult RA, Still Important

Uveitis is inflammation inside the eye (often the iris area in anterior uveitis). It’s more commonly associated
with other inflammatory conditions, but it can occur in people with RA. When it happens, it can be vision-threatening
and needs timely care.

Possible symptoms: eye pain, significant light sensitivity, blurred vision, floaters, and redness.
Because it’s internal inflammation, it’s not something you can diagnose with a mirror and vibesyou need an eye exam.

5) Corneal Complications: Peripheral Ulcerative Keratitis (PUK) and “Corneal Melt”

This category is rarer, but it’s the heavy hitter. Peripheral ulcerative keratitis (PUK) involves inflammation
and breakdown at the edge of the cornea. In severe cases it can progress quickly and threaten the structural
integrity of the cornea.

Warning signs may include: significant pain, redness, light sensitivity, decreased vision,
and the feeling that something is very wrong (technical term: “yikes”). PUK is considered an urgent situation
and often requires aggressive treatment and close monitoring.

6) Medication-Related Eye Issues: What to Watch (Not Panic) About

RA medications can be vision-savers because they control inflammation. Still, a few deserve special eye attention:

• Hydroxychloroquine (Plaquenil) can, rarely, cause retinal toxicity with long-term use.
  Risk is influenced by dose, duration, and certain health factors. The key is regular screening
  so problems are caught early.
• Corticosteroids (especially long-term or high-dose) can raise eye pressure (risking glaucoma)
  and increase the risk of cataracts. Steroids are sometimes necessaryand very effectivebut should be monitored.

A good rule: if a medication has a known eye-related risk, your care team usually has a monitoring routine.
Your job is not to memorize every medical guidelineyour job is to show up for the recommended eye exams.

Symptoms You Shouldn’t Ignore

Dryness and mild irritation are common. But some symptoms deserve faster action. Seek prompt eye evaluation if you have:

• Deep eye pain, especially pain that worsens with eye movement
• New or worsening light sensitivity (photophobia)
• Sudden blurred vision or vision loss
• Floaters with decreased vision or significant light sensitivity
• Severe redness plus pain (not just “I stayed up too late” redness)
• Eye pain with headache, halos, or nausea (possible high eye pressure concern)

If you’re ever stuck choosing between “it’s probably fine” and “I should get checked,” choose checked.
Eyes are not the place to practice optimism.

How Doctors Diagnose RA-Related Eye Problems

Diagnosis usually starts with a comprehensive eye exam. Depending on symptoms, the ophthalmologist may use:

• Slit-lamp exam to examine the ocular surface and inflammation patterns
• Tear testing (like tear quantity/quality checks) for dry eye
• Corneal staining to spot surface damage
• Eye pressure measurement (especially important if steroid exposure is part of the picture)
• Retinal imaging (like OCT) and visual field testing when monitoring for medication effects

Coordination matters: your rheumatologist understands systemic inflammation; your ophthalmologist understands
the eye’s tissues and urgency levels. When they communicate, outcomes tend to improve.

Treatment Options: From “Simple Fixes” to Serious Care

Dry Eye Care That Actually Helps

• Artificial tears (often preservative-free if you’re using them frequently)
• Gel drops or ointments at night for longer-lasting moisture
• Warm compresses and lid hygiene if oil glands are part of the problem
• Prescription anti-inflammatory drops (such as cyclosporine or lifitegrast) when inflammation is driving symptoms
• Punctal plugs to help keep tears on the eye longer in select cases
• Environmental tweaks: humidifier, avoiding direct fan/vent air, wraparound sunglasses outdoors

Dry eye treatment is often a “combination lock,” not a single magic drop. The goal is comfort, corneal protection,
and better daily function (reading, driving, screensyour real life).

Treating Episcleritis and Scleritis

Management depends on severity and the specific diagnosis. Episcleritis may respond to lubricants or anti-inflammatory
approaches. Scleritis typically requires more aggressive therapy and evaluation for systemic inflammation control.

Important note: do not self-treat a painful red eye with leftover steroid drops unless an eye doctor
specifically told you to. Steroids can be appropriatebut in the wrong situation (like certain infections), they can make things worse.

Uveitis and Corneal Emergencies

Internal inflammation (uveitis) and corneal complications like PUK require urgent ophthalmology care. Treatment may
include targeted anti-inflammatory drops, systemic therapy, and close follow-up. These are not “wait-and-see” situations.

Long-Term Eye Protection When You Have RA

You can’t always prevent autoimmune curveballs, but you can stack the odds in your favor:

• Get regular eye exams, especially if you have persistent dryness, a history of eye inflammation, or are taking medications that require monitoring.
• If you take hydroxychloroquine, follow recommended retinal screening schedules (often baseline testing and then periodic screeningfrequently annual after several years of use, depending on your risk factors).
• Tell your doctors about new symptoms earlythe “I didn’t want to bother anyone” approach is not a great eye-care plan.
• Control systemic inflammation with your rheumatology team; eye health often improves when RA is well-managed.
• Protect your eyes from dryness triggers: long screen sessions, low humidity, smoke exposure, and dehydration can all ramp up symptoms.

Bonus practical tip: if screens trigger symptoms, try the “20-20-20” habit (every 20 minutes, look 20 feet away for 20 seconds).
It’s not a cure, but it helps reduce stare-induced blink failureyes, that’s a real thing, and yes, your eyes are judging your blink rate.

FAQ: Quick Answers to Common Questions

Can rheumatoid arthritis cause blurry vision?

It can. Blurry vision may come from dry eye (often fluctuating and improved by blinking), inflammation (like uveitis or scleritis),
corneal damage, or medication-related effects. Any persistent or sudden change should be evaluated.

Is dry eye always Sjögren’s if I have RA?

Not always. RA itself can contribute to dry eye, and so can eyelid oil gland issues, environment, and medications.
Secondary Sjögren’s is common enough that it’s worth discussing with your clinicianespecially if you also have dry mouth or severe fatigue.

Do I need an ophthalmologist or is an optometrist enough?

Many people start with an optometrist for dry eye evaluation, which is great. But if you have suspected eye inflammation,
severe pain, light sensitivity, or complex medication monitoring (like hydroxychloroquine retinal screening), an ophthalmologist is often the best fit.

How do I tell the difference between “pink eye” and RA inflammation?

You can’t always by symptoms alone. Classic infectious conjunctivitis often has discharge and irritation. RA-related inflammation,
especially scleritis or uveitis, is more likely to cause deep pain, light sensitivity, and vision changes. When unsure, get examined.

If my RA is under control, can I still get eye problems?

Yes, but risk is generally lower when systemic inflammation is well-managed. Some eye issues (like dry eye) can be chronic,
and medication monitoring remains important even when you feel well.

Conclusion

Rheumatoid arthritis can affect the eyes in ways that range from annoying (dry eye) to urgent (scleritis, uveitis, corneal complications).
The best strategy is a simple one: recognize red-flag symptoms, keep up with eye exams (especially when taking medications that require screening),
and treat dryness and inflammation earlybefore they start interfering with your daily life.

If you take away just one idea: painful red eye + RA is a reason to get checked promptly.
And if your eyes feel dry every day, that’s not your personality nowit’s a treatable medical issue.

Real-World Experiences: What Living With RA Eye Issues Can Feel Like

Medical descriptions are helpful, but day-to-day experience is what actually makes people say, “Okay, I’m calling the eye doctor.”
Here are common patterns people with RA reportalong with the practical realities that don’t always fit neatly into a brochure.

The “Sandpaper Morning” Routine

Many people describe waking up with eyes that feel gritty or stucklike their eyelids and eyeballs had a disagreement overnight.
Mornings can be the worst because tear production and eyelid oil flow may not keep up during sleep. Some people also notice
that their vision is temporarily blurry when they first wake up, then clears after blinking or using lubricating drops.

What often helps in real life: thicker nighttime lubrication (ointment or gel), a bedroom humidifier, and a “don’t rub your eyes”
ruleeven though rubbing is emotionally satisfying for about two seconds. People also learn that not all artificial tears feel the same.
Some prefer preservative-free single-use vials when drops are needed often.

When Screens Turn Into a Symptom Amplifier

A lot of RA patients connect their eye discomfort to workdays: Zoom meetings, spreadsheets, and phone scrolling.
The hidden issue is that people blink less when they concentrate, and less blinking means the tear film evaporates faster.
This can create a cycle where the eyes burn, the vision fluctuates, and the person squints morewhich makes everything feel worse.

People who find relief usually build small habits rather than chasing a single “perfect” solution: the 20-20-20 rule,
nudging the monitor lower so the eyelids cover more of the eye surface, and keeping drops at the desk like they’re part of the office supplies.
The most common emotional reaction is relief that it isn’t “in their head”it’s physiology and inflammation.

The Flare That “Moved Into the Eyes”

Some people expect flares to show up in joints first, but eye inflammation can feel like a surprise plot twist.
A common story is noticing one intensely red eye with deep pain that feels different from irritationsometimes paired with
light sensitivity and tearing. People often try a warm compress or assume allergies, then realize the pain is escalating
or the eye is tender with movement.

What stands out in these experiences is how quickly treatment can matter. People who are evaluated promptly often describe
a turning point: “Once they figured out it was scleritis (or another inflammatory issue), the plan finally made sense.”
They also notice how important coordination iseye specialists treating the eye and rheumatology adjusting systemic therapy
so it doesn’t keep coming back.

The Medication Monitoring Mindset

People taking hydroxychloroquine often have mixed feelings: it can be a workhorse medication for RA control, but the idea
of retinal toxicity sounds terrifying. The real-world experience is usually calmer than the internet makes it: routine
screening appointments, imaging tests that are painless, and a lot of “everything looks stablesee you next year.”

The most helpful reframing people report is this: eye screening isn’t a sign something is wrongit’s proof the system is working.
Catching early changes is the goal. Similarly, people who need steroidsshort-term or longerlearn to ask practical questions:
“Do I need eye pressure checks?” “How long will I be on this dose?” That kind of teamwork reduces anxiety and risk.

Learning What “Normal” Doesn’t Have to Mean

Perhaps the most common experience is realizing they’ve been tolerating symptoms for too long. Dryness becomes the background noise
of daily life until someone asks the right question: “Do your eyes burn every day?” People often say yesand then realize
they assumed that was inevitable with RA. It isn’t.

With the right plan, many report better comfort, less redness, fewer headaches from squinting, improved contact lens tolerance,
andmaybe most importantlyless worry. The goal isn’t perfect, never-dry eyes. The goal is eyes that let you live your life
without constantly negotiating with your own eyeballs.