Sometimes eye damage occurs with rheumatoid arthritis. About 30 to 40% of people with RA will have some eye symptoms. Most people suffer from both eyes. In addition, vision problems are a rare but serious complication of the hydroxychloroquine medication commonly used to treat RA. For these reasons, people with RA may require regular eye examinations.

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Some common ocular conditions, as described below, can affect people with rheumatoid arthritis (RA). But there are measures that need to be taken to protect eye health and prevent permanent damage.

Eye damage in rheumatoid arthritis

Dry eyes and other symptoms

Redness, irritation, discomfort. This is all related to dry eyes, and in the past, they may have been the reason for many people not to choose to wear contact lenses. If you suffer from dry eyes, you should definitely discuss this issue with an eye care specialist. They can provide information about your specific situation and make sure your eyes are healthy.




Dry eye syndrome is the most common problem for people with RA. The medical term for this condition is “keratoconjunctivitis dry”, a possible eye damage in rheumatoid arthritis. A dry eye happens when the eyes create too few tears or the right quality of tears to keep your eyes moist. This causes symptoms such as burning, pain, or blurry vision. You may feel something is stuck in your eye. Symptoms may be worse at the end of the day. Dry eye syndrome is associated with secondary Sjogren’s syndrome.

The test used to diagnose dry eye syndrome is called the Schirmer test. The test is carried out by placing a small paper tape inside the bottom cover of each eye. Five minutes later, your doctor will check how wet the strip is. The results show if your lacrimal glands (tear glands) work.

Simple steps like using sunglasses, using a moisturizer, and preventing dry environments can help. If your symptoms are severe, your doctor may recommend tear replacements.

RA can cause inflammation in other parts of the eye, including:

  • Scleritis: inflammation of the protein of the eyes.
  • Episcleritis: inflammation of the layer covering the sclera (white part of the eyes).
  • Keratitis: Inflammation of the cornea. The cornea is a transparent layer covering the colored part of the eye (iris).

Some symptoms of these conditions include:

  • Pain that spreads to your cheek, eyebrows, and temples.
  • Sensitivity to light.
  • Blurred or decreased vision.
  • Red eyes.

Hydroxychloroquine and the risk of vision problems

Hydroxychloroquine is an antimalarial drug that is approved for the treatment of RA. It reduces symptoms such as pain, swelling, and soreness of the joint. Hydroxychloroquine improves physical function and reduces the incidence of RA outbreaks. How to relieve rheumatoid arthritis pain

Vision problems are a possible side effect of hydroxychloroquine if it is used for a long time or at high doses. People who have used this medication for at least 5 years have undergone sensitive vision studies in one study. Overall, 7.5% of people had retinal damage. For people who used lower doses (4-5 mg/kg), 2% of people had retinal damage in the first 10 years of use. After 20 years of use, almost 20% had retinal damage. These results are higher than in other studies. However, studies have generally shown that risk increases with increasing duration and dose, and eye damage occurs with rheumatoid arthritis.



An eyesight test is recommended at the initial stage of taking hydroxychloroquine and while taking this drug. The test can evaluate:

  • How sharp is your vision (“visual acuity”)?
  • The area or general area in which you can see objects.
  • Your ability to distinguish between different colors.
  • Any signs of damage to your retina or other eye structures (“ophthalmoscopy”).

The American Academy of Ophthalmology recommends that you have annual eye tests after five years of taking hydroxychloroquine. Information on the appointment of hydroxychloroquine involves annual eye examinations when taking medication. You may need more frequent eye tests if:

  • You are on a high dose of hydroxychloroquine.
  • You have kidney or liver disease.
  • You are an old man.
  • You have certain vision problems.

Eye Care Specialist Visit

In a person with RA, any change in vision should be evaluated immediately. Even with no eye symptoms, regular eye tests may be recommended to monitor changes in your eyesight.

There are several different types of eye care professionals. The training and experience of each type of professional is completely different, so it is important that you see the right doctor for your needs.

Optician. An optometrist provides primary vision care. This includes conducting eye tests and diagnosing certain eye abnormalities. An optometrist can prescribe corrective lenses and medications to treat eye diseases. The optometrist did not attend medical school and is not a doctor. He graduated from college and received an optometry doctor from a four-year optometry school.

Ophthalmologist. An ophthalmologist is a doctor or osteopathic doctor who is licensed for medical practice and surgery. An ophthalmologist can diagnose and treat all eye diseases. The ophthalmologist graduated from college and medical school, plus at least four years of clinical training. In many cases, people with RA go to an ophthalmologist to solve eye problems.



Neuro-ophthalmologist. These doctors treat vision problems associated with the nervous system, not the eyes. They are ophthalmologists with specialized training in problems related to the eye, brain, nerves, and muscles. The neuro-ophthalmologist graduated from college and medical school, as well as at least five years of clinical training.

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