Rheumatic and autoimmune disease in the eye
- Eye and systemic disease
Rheumatic diseases dry, inflame and sometimes melt the eye. Some eye signs are emergencies, and children with arthritis need screening.
What it is
Autoimmune and rheumatic diseases affect almost every part of the eye. Dry eye is the commonest problem. Inflammation of the sclera, cornea or uvea can threaten sight and often reflects active systemic disease. The drugs used to treat these diseases (corticosteroids, hydroxychloroquine) have their own eye toxicity.
Eye findings
- Rheumatoid arthritis: dry eye, episcleritis, scleritis and peripheral ulcerative keratitis (corneal melting).
- Sjögren disease: severe aqueous-deficient dry eye with dry mouth.
- Systemic lupus: dry eye, cotton-wool spots and retinal vasculitis; vascular occlusions with antiphospholipid antibodies.
- Spondyloarthritis (HLA-B27) and inflammatory bowel disease: acute anterior uveitis, unilateral and recurrent.
- Juvenile idiopathic arthritis: chronic anterior uveitis with a white, painless eye.
- ANCA vasculitis: scleritis, orbital inflammation and corneal ulceration.
Screening and follow-up
- Children with juvenile idiopathic arthritis, especially oligoarticular, ANA-positive and with early onset, need slit lamp screening every few months.
- Scleritis or peripheral ulcerative keratitis in rheumatoid arthritis signals systemic vasculitis and needs systemic immunosuppression.
- Long-term corticosteroids cause cataract and glaucoma; hydroxychloroquine causes retinal toxicity.
Next step / Initial management
- Dry eye: lubricants and treatment of lid disease; test for Sjögren if there is a dry mouth.
- Painful red eye with photophobia, severe boring pain or a corneal melt: same-day ophthalmology.
- Juvenile idiopathic arthritis: refer at diagnosis for slit lamp screening at the interval set by risk.
- Hydroxychloroquine: baseline exam and yearly retinal screening after five years (or earlier with risk factors).
- Recurrent uveitis: joint work between ophthalmology and rheumatology.
Test yourself
Think of the answer, then tap the question to see it.
Which children with juvenile idiopathic arthritis are at highest risk of uveitis?
Those with oligoarticular disease, positive ANA and early onset.
What does peripheral ulcerative keratitis in rheumatoid arthritis suggest?
Active systemic vasculitis, needing urgent ophthalmology and systemic immunosuppression.
Which uveitis is typical of HLA-B27 disease?
Acute, unilateral, recurrent anterior uveitis.
Connections
In Pharmacology2
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Sjogren Disease (StatPearls Publishing (NCBI Bookshelf), 2025); HLA-B27 Syndromes (StatPearls Publishing (NCBI Bookshelf), 2023); Juvenile Idiopathic Arthritis (StatPearls Publishing (NCBI Bookshelf), 2026); Scleritis (StatPearls Publishing (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.