TNF and dry eye syndrome: The most frequent ocular manifestation of RA is keratoconjunctivitis sicca.8 Other reported ocular complications of RA are episcleritis, scleritis, retinal vasculitis, peripheral ulcerative keratitis, and interstitial keratitis.9 Cytokines such as interleukin 1 (IL-1), IL-6, and tumor necrosis factor alpha (TNF-α) are believed to play a major role in the development of extra-articular findings in RA.