Approximately 10% of people with inflammatory bowel disease experience eye problems. Most of these are treatable and do not pose any significant threat as far as loss of vision is concerned. Still, if you notice any type of eye irritation or inflammation, bring it to your doctor's attention sooner rather than later.
Types of Eye Disorders
Uveitis One of the most common eye complications in IBD is uveitis, defined as painful inflammation of the uvea—the middle layer of the eye wall. Individuals with uveitis may notice pain, blurred vision, sensitivity to light, and redness of the eye. These symptoms may come on gradually or quite suddenly. To make a diagnosis of uveitis, an ophthalmologist (a doctor who specializes in diseases of the eye) uses a "slit lamp." This is a special microscope that allows the doctor to look at the inside of the eye. Uveitis generally improves when the IBD is brought under control, but the ophthalmologist may prescribe special eye drops containing steroids to help reduce inflammation. If left untreated, uveitis may progress to glaucoma—a disease of the eye marked by increased pressure within the eyeball—and possible vision loss.
Keratopathy This eye disorder is an abnormality of the cornea that develops in some people with Crohn's disease. Again, an ophthalmologist uses a slit lamp to make the diagnosis by spotting white deposits at the edge of the cornea. Keratopathy does not cause any pain or lead to loss of vision, so usually it does not require treatment.
Episcleritis This condition is an inflammation of the outer coating of the white of the eye, called the episclera. When the tiny blood vessels of the episclera become inflamed, they dilate and the area becomes red. In addition, episcleritis also may produce pain and tenderness. Steroid eye drops and topical vasoconstrictors are commonly used to treat episcleritis, but the condition may resolve on its own as the patient's inflammatory bowel disease starts to improve.
Dry eyes A deficiency in vitamin A may result in dry eyes (also known as keratoconjunctivitis sicca or KCS). This condition, which is caused by decreased tear production or increased tear film evaporation, may then lead to eye infection and irritation such as itching and burning. If the infection becomes severe, antibiotics may be necessary. Another possible consequence may be night blindness. Artificial tears provide relief of symptoms. Vitamin A supplements, taken either orally or given as intramuscular injection, can correct the deficiency.
Other problems Inflammation may develop in other areas of the eye such as the retina and the optic nerve, although this occurs infrequently. Also, it is not only the IBD itself that may cause eye disorders; sometimes the medications used to treat the disease create their own set of problems. For example, long-term use of corticosteroids may lead to glaucoma and cataracts (clouding of the lens of the eye that impairs vision).
Summary
Although not everyone with Crohn's disease or ulcerative colitis will experience IBD-related eye conditions, a regular examination by an ophthalmologist is very important. Early detection of eye problems generally results in successful treatment and preservation of healthy vision.
