Ophthalmic manifestations in patients with inflammatory bowel disease: A review

Abstract

Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn's disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

Keywords: Crohn’s disease; Eye manifestations; Inflammatory bowel disease; Ocular complications; Ulcerative colitis.

Figure 1

Diffuse episcleritis. A: Superior view; B: Episcleral injection at slit lamp exam; C: Inferior view. Personal archive.

Figure 2

Classification of scleritis[64].

Figure 3

Clinical presentation of scleritis. A: Anterior diffuse scleritis (personal archive); B: Anterior nodular scleritis (personal archive). The differential diagnosis is based on the presence of a sclera nodule (arrow); C: Anterior necrotizing scleritis, showing the avascular area of necrosis (arrow) (personal archive); D: Anterior necrotizing surgically-induced scleritis, induced by scleral biopsy (courtesy of Prof. Andre Curi).

Figure 4

Anterior uveitis. A: Slit lamp exam revealed posterior synechiae (red arrow) and pigment deposits on the anterior lens capsule (blue arrow) (personal archive); B: Inflammatory cells in the anterior chamber of the eye causing hypopyon (arrow) (personal archive).