Dry Eye & Systemic Inflammation

How systemic inflammation can affect your tears

Dry eye can be part of a broader inflammatory or autoimmune condition. Beyond rheumatoid arthritis, several disorders can affect the tear-producing glands, eyelid oil glands or tissues around the eyes. The result may be too few tears, faster evaporation, or a combination of both. Having one of these conditions does not mean that severe dry eye or permanent gland damage is inevitable.

Three ways the tear film can be affected

Reduced tear production: Inflammation of the lacrimal glands can reduce the watery component of tears, causing aqueous-deficient dry eye.

Unstable tear quality: Meibomian gland dysfunction can alter the oils that help slow evaporation. Eyelid and ocular-surface inflammation may further destabilize the tear film.

Increased exposure: Changes in eyelid position or incomplete blinking can leave the eye surface insufficiently protected, even when tears are being produced.

Sjögren’s disease

Sjögren’s is a particularly important autoimmune cause of dry eye. Immune activity affects moisture-producing glands, often causing both dry eyes and dry mouth. It may occur on its own or alongside rheumatoid arthritis or lupus. Tear deficiency can be substantial, but severity varies. Persistent mouth dryness, frequent dental problems, fatigue or joint symptoms are useful clues to discuss with your doctors.

Rheumatoid arthritis

People with rheumatoid arthritis may develop dry eye, sometimes with coexisting Sjögren’s disease. However, a painful red eye should not automatically be attributed to dryness: rheumatoid arthritis can also be associated with inflammation of the sclera or cornea that needs prompt assessment.

Systemic lupus erythematosus

Dry eye is more common in people with lupus. Inflammation may affect tear production and the ocular surface; meibomian gland dysfunction or coexisting Sjögren’s can also contribute. The pattern and severity differ between patients. Lupus does not invariably cause severe damage to the tear glands.

Systemic sclerosis (scleroderma)

Systemic sclerosis can affect the tear glands and eyelids through inflammation and fibrosis, or scarring. Eyelid stiffness and less complete blinking may also contribute to tear-film instability. Both reduced tear production and evaporative dry eye have been reported, so an examination should assess more than tear quantity alone.

Psoriasis and psoriatic arthritis

Studies in psoriasis have found increased meibomian gland abnormalities and tear-film instability. Eyelid inflammation can contribute to evaporative dryness, although findings vary and gland loss is not inevitable. People with psoriatic arthritis can also develop inflammatory eye conditions such as uveitis. Pain, marked light sensitivity or reduced vision warrants prompt evaluation.

Rosacea with eye involvement

Rosacea is a chronic inflammatory condition, rather than a classic systemic autoimmune disease. When it affects the eyes, inflamed eyelid margins and clogged oil glands can contribute to evaporative dry eye, burning and recurrent styes. Eye symptoms may occur with or without obvious facial redness. Learn about ocular rosacea →

Thyroid eye disease

Thyroid eye disease, most often associated with Graves’ disease, can cause swelling around the eyes, eyelid retraction and eye protrusion. These changes may interfere with blinking or full eyelid closure, increasing surface exposure and evaporation. Lacrimal gland dysfunction can also contribute. New double vision, reduced vision or difficulty closing the eyes needs timely specialist assessment.

Sarcoidosis

Sarcoidosis causes clusters of inflammatory cells called granulomas. Involvement of the lacrimal glands can impair their function and reduce tear production. Sarcoidosis can also cause inflammation inside the eye, so persistent redness, pain or visual changes require examination.

Inflammatory bowel disease

Crohn’s disease and ulcerative colitis are associated with a higher risk of dry eye and other eye problems. Lacrimal gland dysfunction and ocular inflammation may contribute; medication effects and nutritional deficiencies can matter in some patients. Eye symptoms are not always a direct reflection of bowel symptoms. Episcleritis, scleritis and uveitis require different care from routine dry eye.

When to look beyond the eyes

Tell your eye doctor about persistent dry mouth, joint pain or swelling, skin changes, thyroid disease, bowel inflammation and any established autoimmune diagnosis. Bring your medication list and explain when symptoms began. Dry eye alone does not diagnose an autoimmune disorder. Your history and examination guide whether targeted testing or coordination with your primary care clinician, rheumatologist, dermatologist, endocrinologist or gastroenterologist is appropriate.

A plan for your eyes and overall health

Our Westwood dry eye evaluation assesses tear production, tear stability, eyelid closure, meibomian gland function and the condition of the ocular surface. Treatment is matched to the findings and may include preservative-free lubricants, prescription anti-inflammatory eye drops and care for accompanying eyelid disease. Selected patients may need additional tear-conservation or surface-protection measures. Your medical team manages the systemic condition while your eye doctor monitors the eyes. Do not stop prescribed medicines without discussing them with the prescriber.

Seek prompt eye care for significant pain, pronounced light sensitivity, sudden vision changes or a persistently very red eye. These symptoms may indicate something more than uncomplicated dry eye.

Explore a dry eye evaluation →

Patient resources and research

American Academy of Ophthalmology: Arthritis and your eyes
NIH / NIAMS: Psoriatic arthritis
NIH / NIAMS: Sjögren’s disease
NIH / NIAMS: Diagnosis and treatment
TFOS DEWS II: Dry eye mechanisms
Research review: Dry eye in lupus
Clinical research: Dry eye in systemic sclerosis
Clinical research: Psoriasis and meibomian glands
American Academy of Ophthalmology: Ocular rosacea
American Thyroid Association: Thyroid eye disease
Research review: Ocular sarcoidosis
Population study: IBD, dry eye and ocular-surface injury