Conjunctival Microbiome Key Player in Pathogenesis of RA-associated Dry Eye

Changes in predicted metabolic pathways in RA-associated dry eye patients strongly indicate an active role of the ocular surface microbiome in ocular surface pathology. Photo: Alexandra Wiechmann, OD. Click image to enlarge. Previous data has shown a connection between arthritis and eye health. A recent study, presented Monday at ARVO 2026 in Denver, specifically aimed to characterize the conjunctival sac microbiome in patients with rheumatoid arthritis (RA) and secondary dry eye (DE). Researchers sought to determine whether specific microbial structural alterations, functional shifts and changes in bacterial ecology are associated with the ocular surface pathology in this population.The team performed rRNA gene sequencing on conjunctival sac samples from RA patients with secondary dry eye, as well as healthy controls. Analyses aimed to better understand organism diversity, abundance and life cycle.RA-DE patients exhibited significant dysbiosis (i.e., imbalance). Taxonomically, healthy controls were dominated by Stenotrophomonas, whereas RA-DE patients showed enrichment of Corynebacterium, Staphylococcus and anaerobic species, according to the ARVO abstract. Analysis revealed a destabilized microbial ecosystem in arthritis patients with dry eye. Functionally, the RA-DE microbiome was predicted to shift from efficient aerobic metabolism and beneficial biosynthetic pathways towards potentially proinflammatory pathways. RA with secondary dry eye is characterized by a profound remodeling of the conjunctival sac microbiome, the researchers determined. They discovered that in these patients, the ocular bacterial ecosystem is disorganized, unstable and out of balance. This chaotic bacterial community appears to produce different substances and may even trigger inflammation, they noted. “Changes in predicted metabolic pathways, especially the shift from aerobic metabolism to fermentation and the activation of stress-response pathways, strongly indicate an active role of the ocular surface microbiome in ocular surface pathology,” the study authors wrote in their abstract.This finding is important because it suggests that dry eye in RA patients isn't just a surface-level issue—it may be actively driven by these underlying changes to the microbiota. The authors concluded that understanding this correlation opens up new possibilities for treating dry eye by restoring a healthy balance to the eye’s microbiome.Original abstracts ©2026 Association for Research in Vision and Ophthalmology. Click here for the source.  Wu H, Jin X, Zhang C. Characterizing the conjunctival microbiome in dry eye secondary to rheumatoid arthritis. ARVO 2026 annual meeting. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.