Approximately 25 % of patients with rheumatoid arthritis (RA) will have ocular manifestations. keratoconjunctivitis sicca, scleritis, episcleritis, keratitis, peripheral corneal ulceration, and other less common entities such as choroiditis, retinal vasculitis, episcleral nodules, retinal detachments, and macular edema.
Keratoconjunctivitis sicca, or dry eye syndrome, is the most common ocular manifestation of RA and has a reported prevalence of 15 to 25 %. The patient reports a gritty sensation in the eyes .
Scleritis and episcleritis as causes of recurrent red eyes are distinguished on the basis of anatomy and appearance. Symptoms may be similar, but the pain in scleritis is more evident and severe. Tenderness to palpation of the globe can help differentiate the two. After asking the patient to look down with eyelids closed, the physician gently presses the globe. Patients with scleritis have tenderness on palpation, while those with episcleritis do not.. Unlike scleritis, patients with episcleritis do not complain of blurred vision or photophobia. The importance of correctly diagnosing and distinguishing between scleritis and episcleritis is based on the potential ocular and systemic complications associated with scleritis. Studies have shown that patients with RA-associated scleritis have more widespread systemic disease and a higher mortality rate than those episcleritis.
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