From the Guidelines
Yes, there are ophthalmologic findings associated with Crohn's disease, with the most common being episcleritis, scleritis, and uveitis. These ocular manifestations occur in approximately 4-12% of patients with Crohn's disease, with patients experiencing eye redness, pain, photophobia, and blurred vision 1. The treatment of these conditions, such as uveitis, requires prompt initiation of topical corticosteroids, with severe or refractory cases potentially necessitating systemic corticosteroids, immunomodulators, or biologics 1. Other less common ocular manifestations include conjunctivitis, keratitis, retinal vasculitis, and optic neuritis. Key points to consider in the management of these patients include:
- Regular ophthalmologic screening for Crohn's patients, especially those with active disease, to prevent permanent vision damage
- Prompt treatment of ocular manifestations to reduce morbidity and improve quality of life
- Consideration of the underlying immune-mediated mechanisms of Crohn's disease in the management of ocular manifestations 1. Given the potential for significant morbidity associated with ocular manifestations of Crohn's disease, early detection and treatment are crucial to prevent permanent vision damage.
From the Research
Ophthalmologic Findings Associated with Crohn's Disease
- Ocular manifestations are associated with Crohn's disease, with a frequency of 4-12% of patients 2, 3, 4.
- The most common ocular presentations in Crohn's disease are episcleritis and uveitis, with episcleritis often correlating with IBD flares, and uveitis presenting independently of IBD activity 2, 5, 4.
- Corneal complications, such as keratoconjunctivitis sicca (dry eye disease) and peripheral ulcerative keratitis, can also occur in patients with Crohn's disease 2, 3.
- Other rare ocular manifestations associated with Crohn's disease include orbital myositis and posterior scleritis 6.
- The risk of developing ocular inflammation in Crohn's disease may be related to the site of bowel involvement and the presence of arthritis 4.
- Treatment of ocular inflammation in Crohn's disease may involve corticosteroids, systemic nonsteroidal anti-inflammatory drugs, and systemic cytotoxic immunosuppressive therapy 2, 5, 6.
Specific Ocular Conditions
- Episcleritis is often associated with IBD flares, and its treatment may involve topical or systemic corticosteroids 2, 5.
- Uveitis can present independently of IBD activity, and its treatment may involve corticosteroids, systemic nonsteroidal anti-inflammatory drugs, or systemic cytotoxic immunosuppressive therapy 2, 5.
- Corneal complications, such as peripheral ulcerative keratitis, may require urgent review and treatment to prevent corneal perforation 2, 3.
- Orbital myositis and posterior scleritis are rare ocular manifestations associated with Crohn's disease, and their treatment may involve high-dose oral steroids, infliximab, or pulsed intravenous methylprednisolone and cyclophosphamide 6.