University of Iowa Health Care

Ophthalmology and Visual Sciences

EyeRounds.org

Scleromalacia in Rheumatoid Arthritis

Contributor: William Flanary, MD

Photographer: Venckus, Antoinette

This patient is an 88-year-old female with a history of rheumatoid arthritis who presented with bilateral eye pain. An external photo of the right eye shows dilated episcleral vessels traversing 360 degrees around the limbus. There is significant scleromalacia around the senile calcific plaque temporally with a deep furrow extending roughly 90% through the sclera. Underlying uvea can be seen on the close-up photo of the right eye. Less advanced scleromalacia is seen nasally. The left eye also exhibits dilated episcleral vessels surrounding the limbus as well as scleromalacia nasally and temporally. Both eyes have an irregular cornea reflex due to significant dryness which also likely contributed to the melt. Rheumatoid arthritis (RA) should be high on the differential diagnosis of patients who present with scleromalacia. Autoimmune damage to the lacrimal gland can result in severe dry eye in patients with RA.

Right eye Left Eye
right eye, external left eye, external
right eye, thinning Left eye, thinning

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last updated: 01/11/2015