[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [The eye in systemic disease](https://durgical.com/en/ophthalmology/areas/systemic/) › Rheumatic and autoimmune disease in the eye # 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. Updated Nov 5, 2026 **See it in 3D:** [Cornea](https://durgical.com/en/anatomy/cornea/) · [Sclera](https://durgical.com/en/anatomy/sclera/) · [Iris](https://durgical.com/en/anatomy/iris/) · [Retina](https://durgical.com/en/anatomy/retina/) ## Key points - Commonest eye problem in rheumatic disease: dry eye. - HLA-B27: acute unilateral anterior uveitis. - JIA: silent uveitis, screen with slit lamp. - Scleritis or corneal melt in RA = active vasculitis. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/rheumatic-and-autoimmune-disease-in-the-eye/) ## Connections ## See it in 3D 4 The structures of Durgical's 3D anatomy where it is found. - [Cornea](https://durgical.com/en/anatomy/cornea/) - [Sclera](https://durgical.com/en/anatomy/sclera/) - [Iris](https://durgical.com/en/anatomy/iris/) - [Retina](https://durgical.com/en/anatomy/retina/) ## Related 5 - [Hydroxychloroquine: retinal screening](https://durgical.com/en/ophthalmology/hydroxychloroquine-retinal-screening/) - [The tear film and ocular surface](https://durgical.com/en/ophthalmology/the-tear-film-and-ocular-surface/) - [The uvea: iris, ciliary body and choroid](https://durgical.com/en/ophthalmology/the-uvea-iris-ciliary-body-and-choroid/) - [Sarcoidosis and Behçet disease in the eye](https://durgical.com/en/ophthalmology/sarcoidosis-and-behcet-disease-in-the-eye/) - [Steroid eye drops: glaucoma, cataract and infection](https://durgical.com/en/ophthalmology/steroid-eye-drops-glaucoma-cataract-and-infection/) ## Related conditions 7 - [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/) - [Sjögren disease](https://durgical.com/en/conditions/sjogren-disease/) - [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/) - [Ankylosing spondylitis](https://durgical.com/en/conditions/ankylosing-spondylitis/) - [Juvenile idiopathic arthritis](https://durgical.com/en/conditions/juvenile-idiopathic-arthritis/) - [Uveitis](https://durgical.com/en/conditions/uveitis/) - [Scleritis and episcleritis](https://durgical.com/en/conditions/scleritis-and-episcleritis/) ## In Pharmacology 2 - [Hydroxychloroquine](https://durgical.com/en/pharmacology/hydroxychloroquine/) - [Prednisone](https://durgical.com/en/pharmacology/prednisone/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) 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](https://www.ncbi.nlm.nih.gov/books/NBK431049/) (StatPearls Publishing (NCBI Bookshelf), 2025); [HLA-B27 Syndromes](https://www.ncbi.nlm.nih.gov/books/NBK551523/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Juvenile Idiopathic Arthritis](https://www.ncbi.nlm.nih.gov/books/NBK554605/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Scleritis](https://www.ncbi.nlm.nih.gov/books/NBK499944/) (StatPearls Publishing (NCBI Bookshelf), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/rheumatic-and-autoimmune-disease-in-the-eye/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/rheumatic-and-autoimmune-disease-in-the-eye/