Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Question:

Are there vision disorders associated with rheumatoid arthritis?

Answer:

It is relatively unusual for rheumatoid arthritis to cause vision problems. However, there are a number of ways that it can affect the eye, including:

• Dry eyes — People with rheumatoid arthritis often have a condition called "SICCA" in which there is reduced tear and saliva production. This leads to dryness of the eyes and mouth. Eye dryness is experienced as a sensation that there is something in the eye ("foreign body sensation"), sensitivity to light, burning or irritation.

• Sclera inflammation — Redness or other discoloration of the sclera (the white part of the eye) may be due to inflammation of one of its layers. These conditions are called episcleritis and scleritis. They may cause mild discomfort or significant pain, irritation and, in severe cases, serious damage to deeper layers of the eye.

• Cornea inflammation — The front of the eye is a tough, clear structure called the cornea. It can become inflamed in rheumatoid arthritis, often from scleritis. This can dramatically reduce vision.

• Corneal infection — Although rare, people with dry eyes or those taking certain immunosuppressive medications are at some increased risk of corneal infection. A careful eye exam and testing can generally detect this serious problem quickly.

• Medication side effects — While rheumatoid arthritis does not commonly affect vision directly, common treatments can. Examples include hydroxychloroquine (which can damage the retina, in the back of the eye) and corticosteroids (which may increase the risk of glaucoma or cataracts).

If you're having vision problems, it's important to see your ophthalmologist for a thorough examination to determine the cause, whether related or unrelated to rheumatoid arthritis.