Rheumatoid arthritis (RA) is an autoimmune disease that affects millions of people worldwide. It is a chronic inflammatory disorder that can affect various parts of the body, including joints, skin, eyes, and internal organs.

While many people are aware of the joint pain and stiffness associated with RA, they may not be aware of the potential impact it can have on the eyes.

What is the Cornea?

The cornea is a clear, dome-shaped tissue that covers the front of the eye. It is responsible for refracting light as it enters the eye, helping to focus it onto the retina, where images are formed.

The cornea also helps to protect the eye from dust, germs, and other foreign particles.

What is Corneal Melting?

Corneal melting, also known as corneal ulceration, is a rare but serious side effect of RA. It occurs when the cornea becomes weakened and thinned, often leading to perforation and vision loss.

Corneal melting can develop rapidly and may require urgent treatment to prevent permanent damage to the eye.

How Does Rheumatoid Arthritis Affect the Cornea?

RA is an autoimmune disease in which the body’s own immune system attacks healthy tissues, causing inflammation. In the eye, this inflammation can lead to a variety of complications, including corneal melting.

The exact mechanism by which RA causes corneal melting is not fully understood, but it is thought to be related to the inflammatory response and the presence of immune cells in the ocular tissues.

Who is at Risk for Corneal Melting?

Corneal melting is a rare complication of RA, but it is more likely to occur in people with severe or long-standing disease.

Other risk factors include the use of certain medications, such as corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), and the presence of other ocular conditions, such as dry eye syndrome and uveitis.

What are the Symptoms of Corneal Melting?

Corneal melting can cause a range of symptoms, including:.

Eye pain and discomfort
Redness and swelling of the eye
Blurred vision
Sensitivity to light
Watery eyes
A feeling that something is in the eye
Decreased vision or vision loss

If you experience any of these symptoms, it is important to seek medical attention immediately to prevent permanent damage to the eye.

How is Corneal Melting Diagnosed?

Corneal melting is typically diagnosed through a comprehensive eye examination, which may include:.

Visual acuity testing
Slit-lamp examination
Corneal topography
Corneal thickness measurement
Fluorescein staining
Eye pressure measurement

Additional testing, such as blood work and imaging studies, may be necessary to evaluate the underlying cause of the corneal melting.

How is Corneal Melting Treated?

Treatment for corneal melting typically involves a combination of medications and surgical procedures. The primary goal of treatment is to halt the progression of the melting and promote healing of the cornea.

Medications commonly used to treat corneal melting include topical antibiotics and anti-inflammatory agents, as well as immunosuppressive drugs. In some cases, systemic medications may be necessary to control the underlying autoimmune disease.

Surgical options for corneal melting may include patching the eye to promote healing, amniotic membrane transplantation to provide a scaffold for tissue regeneration, and corneal transplantation to replace the damaged tissue.

The specific approach will depend on the severity and extent of the corneal melting, as well as the individual patient’s medical history and overall health status.

Can Corneal Melting be Prevented?

While there is no guaranteed way to prevent corneal melting, there are steps that can be taken to reduce the risk of developing this serious complication. These may include:.

Maintaining good control of the underlying autoimmune disease
Monitoring ocular health regularly with a qualified eye care professional
Avoiding the use of corticosteroid eye drops, which can contribute to corneal melting
Using caution with other medications that may increase the risk of ocular complications
Taking steps to promote overall ocular health, such as practicing good hygiene, staying hydrated, and protecting the eyes from injury

The Bottom Line

Corneal melting is a rare but serious complication of rheumatoid arthritis that can lead to vision loss and other ocular complications.

People with RA, particularly those with severe or long-standing disease, are at increased risk for this condition and should be vigilant about monitoring their ocular health. If you experience any symptoms of corneal melting, it is important to seek prompt medical attention to prevent permanent damage to the eye.