Crohn’s Disease Eyes: How Crohn’s Can Impact The Eyes

    Written by Dr. Brian Bressler on November 14, 2019

    About 10% of people with Crohn’s disease experience eye problems as a result of their Crohn’s.

    Most Crohn’s-related eye issues are treatable and do not result in loss of vision. They often occur during flares, but can also develop during times of remission. They can affect one or both eyes.

    When Crohn’s disease shows symptoms outside of your gastrointestinal tract, they’re called extraintestinal manifestations (EIMs). EIMs may affect the skin, eyes, and joints. Rarely, other conditions—including pancreatitis, oral sores, and certain types of kidney stones, among others—may also occur. In some instances, EIMs may actually be the main reason a patient seeks medical attention.

    Here are the main conditions related to Crohn’s that affect the eyes.

    Episcleritis/Scleritis

    Episcleritis and scleritis are characterized by red, inflamed-looking whites of the eye, mild pain, and watery eyes. Of course, “mild pain” is subjective. Some patients may experience itching or burning in the eyes.

    Crohn's episcleritis

    An eye with episcleritis. From https://en.wikipedia.org/wiki/Episcleritis

    While it may resemble the classic “pink eye,” which is usually related to a temporary viral or bacterial infection, episcleritis is somewhat more serious. It affects the thin, outermost layer of tissue between the conjunctiva and the sclera (the connective tissue layer that makes up the white of the eye). While annoying, it does not affect vision and is usually self-limiting. Episcleritis tends to mirror ongoing intestinal disease activity and may respond to drug therapy for Crohn’s.

    Scleritis, however, is somewhat more serious. The pain can be more intense, there may be sensitivity to light and significant production of tears. Unlike episcleritis, this condition can progress to the point that vision is affected, possibly even leading to blindness. Scleritis definitely warrants professional attention.

    Uveitis

    Uveitis is a less common, but more serious condition that involves inflammation of the uvea; the middle layer of the eye. The uvea comprises the iris (the colored portion of the eye), and two other anatomical structures called the choroid and the ciliary body. The most common form of uveitis affects the iris. This is called iritis or anterior uveitis. Disease activity may occur at the same time as flare-ups in the intestines, although it may also occur independently of Crohn’s flares.

    Crohn's uveitis

    Uveitis of the eye. From https://commons.wikimedia.org/wiki/File:Anterior-uveitis.jpg

    Symptoms of uveitis may include:

    • Redness
    • Pain
    • Sensitivity to light
    • Headaches
    • Floating spots in the field of vision (floaters)
    • Diminished vision
    • Whitish patch towards the lower portion of the iris

    Various variations exist, and one or both eyes may be affected.

    If left untreated, uveitis could progress to cause high pressure in the eye (glaucoma), damage to the optic nerve, clouding of the lens of the eye (cataract), or problems with the retina. All forms of uveitis are potentially serious, and warrant immediate medical attention, as vision loss could occur.

    Keratopathy

    Keratopathy is an abnormality of the cornea, the clear front surface of the eye. It does not cause any pain or lead to loss of vision, so usually, it does not require treatment.

    Symptoms include:

    • Pain
    • Eye irritation
    • Eye watering
    • Sensitivity to light
    • Reduced vision
    Keratopathy of the eye.

    Keratopathy. From https://commons.wikimedia.org/wiki/File:Band_keratopathy.jpg

    Dry Eyes

    Dry eyes, also known as keratoconjunctivitis sicca or KCS, is caused by decreased tear production or increased tear film evaporation.

    Symptoms include:

    • Itching
    • Pain
    • Itching
    • Feeling as though sand is in your eyes
    • Redness

    Other Eye Conditions

    Inflammation from Crohn’s may develop in other areas of the eye such as the retina and the optic nerve Crohn’s. Other eye conditions may be related to side effects of treatment, such as corticosteroids. Their long-term use has been associated with a higher risk of developing cataracts.

    Be Proactive

    Extraintestinal manifestations of Crohn’s that affect the eye(s) are fairly common, and in some instances may arise well before Crohn’s has been diagnosed. Accordingly, it’s important to pay attention to nagging symptoms such as unusually red eyes, floaters, blurry vision, pain, or unusually dry or teary eyes. Rather than ignore these symptoms, seek medical attention.

    At best, it could help you and your doctors identify your underlying disease. Once diagnosed, treatments to control your Crohn’s symptoms may also help control the inflammation that is affecting your eyes. Your doctor(s) may also prescribe topical treatments for the eyes.

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