الفهرس 
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Abstract
R
heumatoid arthritis (RA) is an autoimmune systemic inflammatory disease that affects mainly joints, but also has extra-articular manifestations. Extra-articular manifestations include pulmonary, skin, cardiac and ocular manifestations. The most common ocular manifestation is dry eye disease. Dry eye disease is an ocular surface multifactorial disease characterized by loss of tear film stability. Ocular surface symptoms include grittiness, burning sensation, discomfort, blurred vision. Severe dry eye may lead to serious complications as keratitis, corneal ulcer and perforation.
Our study was a case-control study conducted at Ain Shams University Hospitals during the period from August 2020 to February 2021 on 64 patients (i.e. 128 eyes), divided into 2 equal groups (each group 32 patients, i.e. 64 eyes): group A: Rheumatoid arthritis patients, group B: Healthy controls. History taking, physical examination, OSDI, complete ophthalmological exam, schirmer test, TBUT, corneal fluorescein staining was done for all cases.
Our study found high prevalence of dry eye in RA patient compared to healthy controls. Our study showed that prevalence of dry eye in RA patients is 46.7 % according to schirmer test, 40.6% according to TBUT, while as ocular surface symptoms present in all our RA patients and MGD in 53.1% of them. Concerning healthy controls, we found that prevalence of dry eye is 21.9% according to schirmer test, 18.8% according to TBUT, while as ocular surface symptoms present in 50% of controls and MGD in 9.4%of them.
Our study found that there was significant relation between RA activity and OSDI & MGD. But there was no significant relation between RA activity and Schirmer test & TBUT.
CONCLUSION
• Patients with RA have a significantly higher prevalence and severity of dry eye when compared to age- and sex-matched controls.
• There was significant relation between the severity of RA disease and ocular surface manifestations, MGD but no significant relation with TBUT, schirmer test.
• All RA patients should be always examined for dry eye regardless of disease activity.
RECOMMENDATIONS
• Dry eye disease needs more attention in RA patients to avoid complications such as filamentary keratitis. All RA patients should be advised to visit ophthalmology clinic even if the RA activity is low.
• Schirmer test and TBUT sensitivity need further studies especially in cases of mild ocular surface symptoms.