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When Inadequate Treatment of RA Threatens the Vision

The patient with rheumatoid arthritis merely felt a foreign body in her eye. The problem was much more serious than she thought.

Nataneli N and Chai JSM. Bilateral Corneal Perforation N Engl J Med  (2014) 370:650 Feb 13, DOI: 10.1056/NEJMicm1303823

An image-based case study in the current NEJM offers a cautionary tale regarding an important and ideally avoidable complication of rheumatoid arthritis that affects the vision. The patient, a 61-year-old woman with rheumatoid arthritis (RA,had corneal perforations in both eyes, with iris prolapse. She presented with the complaint of a foreign body in her right eye.

She also had long-standing cataracts, with visual acuity 20/400 in the right eye and 220/200 in the left, but was not bothered by them.

Corneal perforations are a surgical emergency which can be prevented by treating the underlying RA with immunosuppressive drugs. Before the corneal symptoms arose, this woman had been taking only naproxen for her RA.