Managing IBD Outside the Gut: Ocular Manifestations

Abstract

Extraintestinal manifestations are common in inflammatory bowel disease (IBD), being reported in over 25% of patients. Ocular complications of IBD occur in around 10% of cases, but may precede systemic symptoms and are usually nonspecific. Complications of therapy, such as cataracts or glaucoma from steroid use or keratoconjunctivitis sicca related to 5-aminosalicylic acid medications, may also involve the eyes. The pathogenesis remains unclear, but factors such as the extent of intestinal disease, disease activity, and the presence of associated arthritis have been associated with ocular involvement. Conjunctivitis, episcleritis, scleritis and uveitis are by far the most common ophthalmic complications of IBD. However, posterior uveitis, intraretinal hemorrhages, vasculitis, choroiditis, optic neuropathy, and vaso-occlusive phenomena may also occur. The most frequent severe ocular manifestation is anterior uveitis (more common in women). It usually presents as a mild anterior nongranulomatous uveitis (60% of the cases). The inflammation in the eye and the inflammation in the gut are rarely correlated. Patients with uveitis, scleritis, and other anterior segment inflammation usually respond to steroids (topical, periocular or systemic). If the inflammation is resistant to steroids, or if appreciable steroid adverse effects are encountered, systemic immunosuppressive treatment should be considered; this is more likely in HLA-B27-positive patients with uveitis. Evaluation of the eye should be a routine component in the care of patients with IBD.

Corneal Manifestations of Inflammatory Bowel Disease

“…13 Reviewing the literature, corneal involvement in IBD has previously been declared an uncommon finding. 14 The first appearance in the literature was reported by Crohn in 1925; Crohn described the concurrent appearance of corneal lesions, namely, keratomalacia and xerophthalmia, in two UC patients. 15 Knox and coworkers presented 4 CD patients with bilateral, small, symmetrical subepithelial infiltrates and scar formation, which did not affect visual acuity because of their peripheral localization.…”

A review of extraintestinal manifestations and complications of inflammatory bowel disease

“…For treating episcleritis, the underlying IBD symptoms should be managed, and additional topical NSAIDs and glucocorticoids may be used. [4042] For treating anterior uveitis, topical corticosteroids and cycloplegics should be used. However, there is limited evidence available regarding the treatment of refractory uveitis and other rare manifestations.…”

Preventive health measures in inflammatory bowel disease

“…Ophthalmologic problems may be related to extraintestinal manifestations of IBD such as uveitis, episcleritis, or keratopathy or may be related to IBD therapy such as glucocorticoid-induced cataracts or glaucoma[52,53]. Vitamin A deficiency may result in keratoconjunctivitis sicca after bowel resection in CD.…”