This woman with this elbow  appearance has a history of painful red eyes.

a. What does the picture show?

Multiple rheumatoid nodules.

b. What is the histopathology of this lesion?

The  rheumatoid nodule is composed of three zones: an inner zone of central necrosis, 
a surrounding cellular palisading zone, and an outer area with perivascular infiltration 
of chronic inflammatory cells, chiefly lymphocytes. Although the aetiology remains 
unknown, immune complex-mediated vessel damage has been proposed to play 
an important .

c. What could be the causes of her ocular pain?

In rheumatoid arthritis, the following may give rise to ocular pain:

• Keratoconjunctiva sicca
• Keratitis with or without peripheral corneal ulceration
• Episcleritis
• Scleritis

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