Bilateral Diffuse Anterior Scleritis With Ocular Hypertension Revealing Rheumatoid Arthritis

Abstract

Rheumatoid arthritis is a chronic systemic autoimmune disease that may involve extra-articular organs, including the eye. Scleritis is a severe and potentially sight-threatening ocular manifestation frequently associated with rheumatoid arthritis. We report the case of a 63-year-old male presenting with a 1-month history of bilateral red and painful eyes associated with photophobia and headache, initially misdiagnosed as glaucoma due to elevated intraocular pressure. Ophthalmologic examination revealed decreased visual acuity, diffuse conjunctival hyperemia, and intraocular pressure of 30 mmHg in both eyes. Laboratory investigations confirmed seropositive rheumatoid arthritis. The patient was treated with systemic and topical corticosteroids along with acetazolamide, leading to significant clinical improvement and reduction in intraocular pressure. This case highlights the importance of considering inflammatory etiologies in patients presenting with ocular hypertension and emphasizes the need for early diagnosis and multidisciplinary management to prevent vision-threatening complications.