Dry Eyes And Arthritis: Key Strategies For Relief

Anyone with arthritis can experience dry eyes for various reasons, but for those with autoimmune types like rheumatoid arthritis (RA), lupus, or Sjögren’s syndrome, dry eyes often become a chronic and painful issue. Severe cases can lead to corneal infections or scarring if untreated. This article covers symptoms, causes, and treatments to help manage this common comorbidity.

Dry Eye Symptoms

Dry eye disease disrupts the tear film, leading to discomfort and vision issues. Common symptoms in arthritis patients include:

• Burning, stinging, or gritty feeling in the eyes, often described as sand under the eyelids.
• Redness of the eyes or eyelids.
• Sensitivity to light (photophobia), making daily activities challenging.
• Blurred or fluctuating vision that may improve temporarily with blinking.
• Profusely watery eyes – paradoxically, this reflexive tearing occurs as the body compensates for dryness but lacks proper lubrication.
• Feeling like something is stuck in the eye (foreign body sensation).
• Stringy mucus discharge or discomfort with contact lenses.

These symptoms can worsen with prolonged screen time, wind, or dry environments, significantly impacting quality of life. Women with RA are up to 9 times more likely to develop dry eye syndrome than men.

Why Eyes Dry Out

The tear film – a precise balance of oily (lipid), watery (aqueous), and mucous layers – keeps eyes lubricated, nourished, and protected. Dry eye arises when production decreases, evaporation increases, or tear quality degrades.

• Aqueous deficiency: Reduced watery tear production from lacrimal gland damage.
• Evaporative dry eye: Meibomian gland dysfunction causes rapid tear evaporation due to insufficient oil.
• Poor tear quality: Imbalanced components fail to coat the eye properly.

In arthritis, autoimmune inflammation targets these glands, compounded by medications and aging.

How Arthritis Causes Dry Eyes

Autoimmune arthritis disrupts ocular moisture through inflammation and glandular attack. Key mechanisms include:

Autoimmune Inflammation

Rheumatoid arthritis (RA) affects 44% of patients with dry eye, the most common ocular manifestation per the American Academy of Ophthalmology. Inflammation damages lacrimal and meibomian glands, reducing tear volume and stability.

Sjögren’s Syndrome

This condition, often co-occurring with RA, primarily attacks moisture-producing glands, causing severe aqueous deficiency. It leads to dry eyes and mouth, affecting up to one-third of lupus patients similarly.

Other Arthritis Types

• Lupus: Causes mild irritation to severe vision loss in some cases.
• Psoriatic arthritis and ankylosing spondylitis: Linked to uveitis and evaporative dry eye.
• Medications like antihistamines, antidepressants, or immunosuppressants exacerbate dryness.

Treatments for Dry Eyes

Management combines lifestyle changes, over-the-counter remedies, prescription options, and specialist care. Consult an eye doctor for personalized plans, especially with arthritis.

Lifestyle and Home Remedies

• Use a humidifier to add moisture to indoor air.
• Follow the 20-20-20 rule: Every 20 minutes, look 20 feet away for 20 seconds to blink more.
• Avoid direct air vents, fans, or smoke.
• Apply warm compresses daily to unclog meibomian glands (10 minutes, followed by gentle lid massage).
• Stay hydrated and use omega-3 supplements (fish oil) to improve tear quality.

Over-the-Counter Options

• Artificial tears: Preservative-free drops 4+ times daily for lubrication.
• Gel or ointment drops at night for longer relief.
• Lid cleansers or hypoallergenic wipes for blepharitis.

Prescription Treatments

• Cyclosporine (Restasis) or lifitegrast (Xiidra): Anti-inflammatory drops to boost tear production.
• Steroid drops short-term for severe inflammation.
• Punctal plugs: Tiny devices inserted to block tear drainage, conserving natural tears.

Advanced Therapies

For refractory cases:

• Intense pulsed light (IPL) therapy or LipiFlow for meibomian gland dysfunction.
• Autologous serum tears from patient’s blood for severe aqueous deficiency.
• Scleral lenses for corneal protection.

Regular monitoring prevents complications like scleritis or uveitis, more common in RA.

Frequently Asked Questions (FAQs)

Can all types of arthritis cause dry eyes?

Primarily autoimmune forms like RA, Sjögren’s, and lupus; osteoarthritis less directly, but medications and age contribute.

Why do my eyes water excessively if they’re dry?

Reflex tearing compensates for poor-quality tears lacking oil and mucin, leading to evaporation and irritation.

Are there medications that worsen dry eyes in arthritis patients?

Yes, antihistamines, decongestants, antidepressants, and some RA drugs reduce tear production.

How often should arthritis patients get eye exams?

Annually or more if symptomatic; early detection prevents vision loss.

Can diet help with dry eyes related to arthritis?

Omega-3 fatty acids (e.g., salmon, flaxseed) reduce inflammation and improve meibomian function.

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medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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