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Red Eye – Not Always An Overnight Flight

Red Eye – Not Always An Overnight Flight

Complications of rheumatoid arthritis extend beyond the joints. RA can affect the lungs, blood vessels, eyes, bones, and more. Fortunately, my RA has been centered around my joints with very little bone erosion. My organs are healthy and I’m doing really well. But recently RA has affected my eyes.

Approximately 25 percent of people living with RA will experience acute, chronic, or recurrent eye problems. Inflammation can attack the eyes and lead to dry eye syndrome (keratoconjunctivitis sicca), scleritis, episcleritis, keratitis (inflammation of the cornea), and uveitis. Certain medications commonly used in RA can also contribute to the development of glaucoma, cataracts, retinal damage, and macular edema.

What were the eye symptoms like?

Last Wednesday when I woke up, part of my left eye was quite red. At first, I suspected an eye infection, perhaps viral conjunctivitis, or severe allergies. My eyeball felt sore and the pressure of my eyelid closing over the red part was painful. I kept checking the redness throughout the day to see if it got worse, stayed the same, or got better. If it were an eye infection, I expected it to get much worse.

The next morning, the redness had spread somewhat, the pain was the same, but there seemed to be no evidence of infection since there wasn’t any goopy discharge. So my suspicions turned to something inflammatory. I called the eye doctor and was able to get an appointment just before the holiday weekend.

Finally getting a diagnosis

He confirmed that I did not have an infection. After a thorough exam, I was diagnosed with episcleritis. During the course of the visit, I learned some important things about scleritis and episcleritis which affect less than 10 percent of RA patients. Dry eyes are much more common.

What are scleritis and episcleritis?

The sclera is the white part of the eye and the episclera is the thin membrane between the sclera and the cornea. Although symptoms of scleritis and episcleritis are similar, there are important differences. Inflammation causes redness in both conditions, but the pain of scleritis is much more severe and complications can be very serious. My doctor used the type of eyes drops that dilate pupils. This solution constricts blood vessels which can reduce redness in episcleritis but not scleritis.

Types of episcleritis

Episcleritis, a more common and benign cause of redness of the eye, has two forms: nodular and simple. Simple episcleritis can be diffuse (affecting the entire white portion of the eye) or sectoral (affecting a segment of the eye). Nodular episcleritis has obvious lumps of inflamed tissue. Both forms of episcleritis might be confused with severe conjunctivitis (eye infection) because of the bright-red, bloodshot appearance of the eye.

What type of episcleritis did I have?

My case of sudden eye redness and mild pain was caused by sectoral episcleritis. Initial treatment is focused on relieving discomfort. My doctor prescribed very strong corticosteroid eye drops to be used several times each day until the redness is gone, followed by a gradual tapering of the dose over several days.

I’ve been told that this flare-up may last for 7-10 days during which time I really can’t wear my contacts because of the eye drops. I’m on day four of treatment and haven’t seen much change yet. (Update: Day 16 and the redness is finally noticeably reduced; not gone yet, but less prominent.) Since episcleritis can be a recurring condition with episodes every few months, I will be prepared to take quick action if it does come back.

If you notice sudden changes in your vision or the appearance of your eyes, please call your eye doctor immediately. It may be something simple and benign, or something much more serious. Careful examination is needed so that you can receive the appropriate treatment.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Tich
    2 years ago

    The doctor who diagnosed my scleritis told me one way he differentiates between episcleritis and scleritis is that the latter does not respond to steroid eye drops; high dose oral steroids is needed. I relocated to Houston shortly thereafter (in 2007) and in my search for new doctors I found that few ophthalmologists had actually seen scleritis, and fewer still had any success treating scleritis. Now in 2017 it is my humble opinion that specialized training in Ocular Immunology is needed to care for Scleritis. It’s just so difficult to achieve remission, and nearly impossible to cure.

  • GingerS
    3 years ago

    So glad to see this article. Actually one of the first symptoms I had was a tear in my right cornea. My eye was very reddened painful. Vision totally blurred. I was seen by 3 eye Drs as they were afraid. I was losing my sight. This occurred two times before I was diagnosed with a positive RAF. The good news is my eye healed. My left eye sclera is subject also to inflamation. No tears yet. whew!
    I do what was recommended to me by the eye Dr. At bedtime I use a nonprescription eye. (Like normal saline, but is a gel) at bedtime. Then in the am if needed I use normal saline eye drops. Vision problem solved. Whew.
    I keep my yearly appointments religiously. Eye sight is a precious thing to have. My mother was blind in one eye and was always!! afraid of losing sight in her good eye.

  • Lori f
    3 years ago

    I had episcleritisin 1996, I had not yet been diagnosed with RA, but was seeing a Rheumatologist for “Inflammatory Polyarthritis” the white part of my eye was so red and swollen that I literally could not fully close my eye. My Rheumatologist said that the episcleritis confirmed my RA diagnosis, since I have a negative Rheumatoid factor. Thankfully that was the only time I had that, but I am plagued with constant dry eye.

  • MaryMF
    3 years ago

    I also have frequent dry eyes, and woke to the scleritis. I’ve been to 2 Dr’s who both said nothing was wrong, and most people I know look at me like I’m lying when I say my AS, RA is in my eyes. I was wondering if the people with dry eyes, if they ache, I smash my fists in my eyes to feel better. The scleritis was more of a sharper pain.

  • Lisa Emrich author
    3 years ago

    Hi Lori,
    I’m so glad to hear that you haven’t had another attack of episcleritis. Now that you mention being neg for Rheumatoid Factor, I wonder if it’s more common for negative folks to have episcleritis or vice versa. I’m also RF neg. Sorry that you have constant dry eyes. That really can’t be pleasant.
    Wishing you well,

  • RHPass
    3 years ago

    Lisa- that must have scared the daylights out you! so glad you could get it looked at right away.
    I had never connected RA to my eye problems- until I had to have holes poked in my irises with a laser! I kid you not! It is called iridotomy, and it is done to provide proper drainage and maintain proper eye pressure. If the pressure gets too high it can cause Narrow angle glaucoma.
    (This is why it is VERY important to have your eyes examined and dilated !any sudden onset of that condition can cause blindness.)

  • Lisa Emrich author
    3 years ago

    Hi RH,

    It was somewhat frightening, but not quite as scary as when I went temporarily blind in my right eye due to multiple sclerosis. Now that was frightening.

    I agree that it’s enormously important to get annual exams including dilation, pressures, and fundus photography. The health of our eyes is too important.

    I’m sorry that have had to have holes poked in your irises. THAT sounds terrifying. Was it painful? I hope that your eyes are doing well now.


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