Spectrum of ocular manifestations in rheumatoid arthritis

Abstract

Background: Ocular manifestations of Rheumatoid arthritis are diverse and may cause surface inflammatory disease affecting the cornea, uvea, episclera, sclera, retina, and orbit. Dry eyes are the most common ocular manifestation. Other diseases include episcleritis, scleritis, peripheral ulcerative keratitis, corneal melt syndrome, uveitis, vasculitis, retinal detachment, disc edema, vitritis and rarely macular edema. Cataract and glaucoma occur as a result of long term use of corticosteroids.

Aim: This study was conducted to find out the spectrum of ocular manifestation in Rheumatoid arthritis.

Methodology:  Patients of rheumatoid arthritis reporting to our institute, from June 2017 to December 2017 underwent complete ocular examination including best corrected visual acuity, slit lamp examination, tear film breakup time, Schirmer test, fluorescence staining, and fundus examination.

Results: We evaluated 87 patients during our study period. The mean age at presentation was 57.7 years with standard deviation (SD) of 9.91 and standard error of the mean (SEx) of 1.06. Among the 87 patients, ocular manifestation was present in only 49 patients (56%) with the dry eye being the most common presentation in about 38 patients (43.6%). Other ocular diseases include episcleritis and scleritis in 4 patients (4.5%), filamentary keratitis in 2 patients (2.2%), peripheral ulcerative keratitis in 2 patients (2.2%), posterior subcapsular cataract in 02 patients (2.2%), and steroid-induced glaucoma in 01 patient (1.1%).

Conclusion: Ocular findings in rheumatoid arthritis patients are frequent. The high prevalence of dry eye suggests that detail ocular examination should be done in these patients and Schirmers test should be performed regularly in these patients. Prevalence of cataract and steroid-induced glaucoma emphasizes that there is a need to prescribe steroids more cautiously in patients with rheumatoid arthritis.