A Review of Ophthalmic Complications in Inflammatory Bowel Diseases

Abstract

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated conditions caused by various polygenic and environmental factors. Clinical manifestations of IBD primarily occur in the gastrointestinal tract, but many patients are affected by extraintestinal complications, including eye diseases. Ocular disorders are the third most common extraintestinal manifestation (EIM), following musculoskeletal and mucocutaneous involvement. Episcleritis, frequently occurring in IBD patients, may be associated with exacerbation of the intestinal disease. Uveitis does not correlate with IBD activity but may be related to the presence of other EIMs, particularly erythema nodosum and peripheral arthritis. Early detection and specific therapy of ocular manifestations of IBD are fundamental to avoiding sight-threatening complications. Therefore, ophthalmic evaluation should be performed in all IBD patients. Systemic corticosteroids or immunosuppressants may be inevitable in severe cases to control ocular inflammation. Persistent and relapsing conditions usually respond well to TNF-α-inhibitors. Interdisciplinary cooperation between gastroenterologists and ophthalmologists is fundamental in initiating the appropriate treatment for patients.

Manifestations of Ocular Autoimmune Diseases - Literature Review

“…In order to reduce pain and discomfort, it is recommended to use cold compresses. [23] In severe or recurrent cases, NSAID therapy may be considered, with cyclooxygenase-2 being preferred. Constant monitoring by a gastroenterologist is then necessary due to the risk of triggering a relapse of the underlying disease.…”

“…In resistant cases, infliximab may be considered. [14,23] Scleritis Scleritis occurs in less than 1% of IBD patients. Unlike episcleritis, it can develop during a period of remission.…”

“…Therapy involves the use of systemic steroids or immunosuppression. [23] Lack of effective therapy may lead to retinal detachment or optic neuritis. [14]…”

“…In severe or refractory cases, periocular or systemic injection or anti-TNF drugs may be considered. [14,23] Depending on the primary outbreak, its severity and duration, it may be complicated, by cataracts, glaucoma, band keratopathy, vitreous hemorrhage, cystoid macular edema, retinal detachment, retinal ischemia, optic atrophy, chronic eye pain and blindness.…”

“…The therapy uses infliximab. [23] Other Infiltrates and scars that may cover every layer of the cornea -both the epithelium, stroma and endothelium. The location of lesions outside the visual axis does not worsen visual acuity.…”