Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that frequently presents with extra-articular manifestations. Ocular involvement is common and can range from mild discomfort to sight-threatening conditions. This review provides a comprehensive overview of the visual complaints and ocular manifestations in patients with RA.

Methods: A literature review was conducted using a systematic approach to identify relevant articles on the ocular manifestations of RA. The search included peer-reviewed articles, clinical trials, and case reports. The focus was on the pathophysiology, clinical presentation, diagnosis, and management of these conditions.

Results: The most common ocular manifestation of RA is keratoconjunctivitis sicca (dry eye syndrome). Other significant anterior segment complications include episcleritis, scleritis, and peripheral ulcerative keratitis. Posterior segment involvement, such as uveitis and retinal vasculitis, is less common but can be more severe. A critical aspect of management is monitoring for drug-induced toxicities, particularly hydroxychloroquine retinopathy, which can cause irreversible vision loss (1). The risk of QT interval prolongation with hydroxychloroquine use, especially with concomitant medications, also warrants consideration (2). Recent clinical trials have provided further insights into the implications of these ocular manifestations (3).

Conclusion: Ocular manifestations in RA are diverse and require a high index of suspicion for early diagnosis and treatment. A multidisciplinary approach involving rheumatologists and ophthalmologists is essential for optimal patient care. Regular ophthalmic screening is recommended for all RA patients, especially those on long-term hydroxychloroquine therapy, to prevent irreversible vision loss and improve quality of life.

Rheumatoid Arthritis, Ocular Manifestations, Visual Complaints

Au SCL. Hydroxychloroquine retinal toxicity: The bull's eye in the human eye. [Published online ahead of print, 2020 June 25]. Vis J Emerg Med. 2020; 21:100818. doi:10.1016/j.visj.2020.100818

Mercuro NJ, Yen CF, Shim DJ, et al. Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease, 2019. (COVID-19) [Published online ahead of print, 2020 May 1]. JAMA Cardiol. 2020; e201834. doi:10.1001/jamacardio.2020.11834

Bhamra MS, Gondal I, Amarnani A, et al. Ocular Manifestations of Rheumatoid Arthritis: Implications of Recent Clinical Trials. Int J Clin Res Trials. 2019; 4(2):139. doi:10.15344/2456-8007/2019/139