Ocular Manifestations in Rheumatoid Arthritis
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Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of this autoimmune disease vary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Their appearance, as well as their severity, are related to RA chronicity and resistance to therapy. The treatment consists of corticosteroids, NSAIDs and cytotoxic drugs, depending on the type of ocular manifestations and the patient’s response to treatment.

Keratoconjunctivitis sicca (dry eye syndrome) is the most common eye sign of RA with a percentage of 10% - 35%. It is caused by infiltration of the lacrimal gland by T and B lymphocytes, leading to a secondary atrophy of the gland which is responsible for the decrease of tears. There is a simple test to perform in order to assess the fear production of the gland which is called Schirmer’s test, and it is performed by first drying the tear film, then inserting a Schirmer strip into the lower conjunctival cul-de?sac over the temporal aspect of the lower lid. After 5 min, if the strip measures less than 10 mm of wetting, the lacrimal glands are not functioning correctly.

The symptoms and signs of foreign body sensation which is very irritated, and there is also a hyperemia of the conjunctiva (red eye). The patients complain of a burning sensation of the eye, pain and blurred vision. Mucus discharge and crusts are not uncommon. So the dominant findings of Keratoconjunctivitis sicca are two: diminished corneal tear meniscus and abnormal Schirmer’s test. The primary goal in managing dry eye is to replenish or preserve the tear film. The treatment is a combination of several actions. The patients should avoid dry environments and the overexposure to the sun. Furthermore, they should wear sunglasses and they should prefer rooms with humidifiers. Finally, they should use natural tear substitutes, in extreme cases occlusion of the lacrimal drainage puncta or tarsorrhaphymay be required in order to eliminate the problem

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