Can Rinvoq (upadacitinib) affect vision?

Can Rinvoq Affect Vision?

Yes, Rinvoq (upadacitinib) can affect vision, most notably through retinal detachment in patients with atopic dermatitis, and patients must be instructed to report any sudden vision changes immediately. 1

Primary Ocular Risk: Retinal Detachment

The FDA-approved drug label explicitly warns that separation or tear to the lining of the back part of the eye (retinal detachment) has occurred in people with atopic dermatitis treated with Rinvoq. 1 This is a serious, sight-threatening complication that requires immediate ophthalmologic intervention.

• Patients must call their healthcare provider right away if they experience any sudden changes in vision during treatment with Rinvoq 1
• This risk appears specific to the atopic dermatitis population, though the mechanism is not fully elucidated 1

Clinical Context and Monitoring

When to Use Rinvoq

Upadacitinib is a selective JAK-1 inhibitor approved for moderate-to-severe atopic dermatitis patients who have failed other systemic therapies (immunosuppressants, corticosteroids, antimetabolites, injectable biologics) or when these are inadvisable 2. It is not considered first-line systemic therapy in most circumstances 2.

Baseline and Ongoing Monitoring

While the 2024 American Academy of Dermatology guidelines recommend baseline laboratory monitoring (complete blood count, liver enzymes, lipids, viral hepatitis, tuberculosis screening), no specific baseline ophthalmologic examination is mandated for Rinvoq initiation 2. However, given the retinal detachment risk:

• Educate all patients starting Rinvoq about the warning signs of retinal detachment: sudden flashes of light, floaters, curtain-like shadow over visual field, or sudden vision loss 1
• At each follow-up visit, specifically ask about any vision changes 1
• Immediate ophthalmology referral is required for any sudden visual symptoms 1

Comparison with Other Atopic Dermatitis Treatments

The visual risk profile differs significantly from dupilumab and tralokinumab (IL-4/IL-13 inhibitors), where conjunctivitis is the primary ocular concern 2:

• Conjunctivitis with dupilumab/tralokinumab is common but typically self-limited and managed with artificial tears 2
• Ophthalmology referral for dupilumab/tralokinumab is considered only if conjunctivitis is severe, persistent, or refractory to conservative measures 2
• In contrast, Rinvoq's retinal detachment risk requires immediate ophthalmologic evaluation for any vision change 1

Additional Safety Considerations

The FDA has applied class-wide warnings to JAK inhibitors regarding increased risks of serious cardiovascular events, cancer, blood clots, and death based on safety data from other JAK inhibitors in other populations 2. While these systemic risks don't directly affect vision, they inform the overall risk-benefit calculation when choosing Rinvoq over alternatives.

Management Algorithm

If a patient on Rinvoq reports vision changes:

1. Same-day ophthalmology evaluation for any sudden vision change 1
2. Do not delay referral while awaiting routine follow-up 1
3. Document the timing of symptom onset relative to Rinvoq initiation and current dose 1
4. Consider discontinuation pending ophthalmologic assessment, particularly if retinal detachment is confirmed 1

Common Pitfalls to Avoid

• Do not dismiss mild visual symptoms as "probably nothing" in Rinvoq patients—retinal detachment can present with subtle early warning signs 1
• Do not confuse the conjunctivitis risk of dupilumab with the retinal detachment risk of Rinvoq—these require different urgency levels of ophthalmologic referral 2, 1
• Do not assume all JAK inhibitors have identical ocular risks—the retinal detachment warning is specific to upadacitinib in the atopic dermatitis population 1