FREQUENCY AND PATTERN OF OCULAR SURFACE DISEASE AMONG ADULTS WITH RHEUMATOID ARTHRITIS IN PAKISTAN

Abstract

Background: Rheumatoid arthritis is a systemic autoimmune disease that can affect the lacrimal glands, tear film, meibomian glands, conjunctiva, cornea, episclera, and sclera. Dry eye disease is the most frequent ocular surface manifestation, while scleritis and peripheral ulcerative keratitis are uncommon but potentially sight-threatening. Pakistani evidence remains limited, and standardized combined rheumatological and ophthalmological assessment is not routinely reported.

Objective: To determine the frequency and pattern of ocular surface disease among adults with rheumatoid arthritis in Pakistan and to identify clinical and laboratory factors associated with ocular surface involvement.

Methods: A prospective observational study was conducted among 220 consecutive adults with rheumatoid arthritis. Participants underwent Disease Activity Score in 28 joints using erythrocyte sedimentation rate assessment, rheumatoid factor and anti-cyclic citrullinated peptide testing, Ocular Surface Disease Index questionnaire, slit-lamp examination, fluorescein tear film break-up time, Schirmer I testing, corneal fluorescein staining, conjunctival lissamine green staining, and meibomian gland evaluation. The primary outcome was ocular surface disease, defined by compatible symptoms with at least one objective abnormality or by a specific inflammatory ocular surface diagnosis.

Results: Ocular surface disease was present in 119 of 220 participants, 54.1%. Dry eye disease occurred in 108 patients, 49.1%, including aqueous-deficient disease in 19.1%, evaporative disease in 17.3%, and mixed disease in 12.7%. Meibomian gland dysfunction was found in 33.2%, corneal fluorescein staining in 29.1%, episcleritis in 3.2%, scleritis in 1.4%, and peripheral ulcerative keratitis in 0.5%. High rheumatoid arthritis activity, disease duration of at least five years, secondary Sjogren syndrome, and rheumatoid factor positivity were independently associated with ocular surface disease.

Conclusion: In this analysis, ocular surface disease affected more than half of adults with rheumatoid arthritis. A structured ocular surface assessment integrated with disease-activity evaluation may identify patients requiring timely ophthalmological care.