This information is in no way meant to be used for the purposes of self-diagnosis or treatment. It is recommended that IBD patients, particularly those with a history of other inflammatory conditions, have regular ophthalmic examinations. If you think you may have eye inflammation, please seek appropriate medical advice.

This section deals primarily with the effects on the eye of the disease process of concomitant autoimmune conditions. Many of the medications used to treat IBD can also affect our eyes. The impact of these medications is discussed in depth, in the Medications section.

The structure of the eye:
The eye is made up of three distinct layers around a fluid filled central cavity. The outer layer, the sclera (the white and cornea), is a protective layer. The sclera can be affected by episcleritis, which involves the white of the eye, or keratopathy, which affects the cornea. The inner layer, the retina, is the sensory part of the eye, used to collect light.

The central layer, the uvea, is the vascular layer. It has three parts: the iris, the ciliary body, and the choroid. It is in these three parts of the uvea that most IBD related inflammatory conditions occur. Collectively, these conditions are known as Uveitis.

Types of Uveitis:

There are different forms of uveitis, depending on which part of the uvea is effected. The following are the most common forms associated with IBD.

Anterior Uveitis (Iritis):
The most common form of uveitis is anterior uveitis, otherwise known as iritis. As the name suggests, it most often affects the iris and front-most structures of the eye, as well as the ciliary body (iridocyclitis). It is closely associated with Ulcerative Colitis and Crohn's disease, as well as Ankylosing Spondylitis, Rheumatoid Arthritis, and Crohn's Associated Arthritis.

The symptoms of iritis are pain, photophobia, excessive tearing, redness, burning, itching, discharge, blurred vision, floaters, and small pupils. Symptoms can develop rapidly. The pain is often described as a dull ache of the eye and ocular orbit. Sensitivity to light can be severe, and excess tearing usually due to over-stimulation. Visual acuity is usually normal, but sufferers may experience some haziness.

Treatment includes warm compresses, as well as dark glasses and pain medication to relieve discomfort. Pain may also be relieved by dilating the pupil in order to prevent motion of the inflamed iris. Corticosteroid drops or ointment may be used to reduce inflammation. In cases of chronic iritis, glaucoma medication may be used to reduce intra-ocular pressure.

Long term complications can include glaucoma, due to increases in intra-ocular pressure, and cataracts as a result of long term steroid use. Most attacks abate within a few weeks, but relapses are common. It is believed that treatment of the underlying causative autoimmune disorder will often bring iritis under control. Patients with chronic uncontrolled anterior uveitis may develop lens scarring and accompanying loss of vision, as well as the aforementioned glaucoma and cataracts.

Posterior Uveitis:
Less common is posterior uveitis, which affects the back area of the uveal tract, and can involve both the choroidal and retinal cell layer. It is sometimes referred to as retinitis, choroiditis, or choroidoretinitis, depending on which areas are affected. It is believed that it most often caused by a systemic infection, but is also associated with Crohn's and Ulcerative Colitis, Ankylosing Spondylitis, Psoriasis, and some forms of Rheumatoid Arthritis.

The symptoms of posterior uveitis rarely involve pain, and are most often, blurred vision, floaters, and vision loss. Sensitivity to light, and distortion in the size and shape of objects is also common. The inflammation causes spotty areas of scarring which correspond to areas of vision loss. If the central part of the retina (the macula) becomes involved, vision may be profoundly impaired.

If discomfort is present, warm compresses and medication may be used to relieve pain, as well as dark glasses to reduce over-stimulation. Steroidal eye drops are used to reduce inflammation. Treatment of the underlying cause is seen as the most effective long-term treatment.

Complications of posterior uveitis can include glaucoma and cataracts, fluid within the retina, retinal detachment, and vision loss.

Intermediate Uveitis (pars planitis)
Least common is Pars Planitis, a posterior/intermediate uveitis, which affects the pars plana, just behind the ciliary body, and the most forward edge of the retina. It is most often found in young patients, and although it is idiopathic and unassociated, there has been implication of an association of autoimmune and demyelinating diseases.

Pars planitis is often asymptomatic, but symptoms can include diminished vision of varying degrees, often progressive, and floaters. In most cases, pars planitis is benign, but in extreme cases, loss of vision is possible.

Conservative treatment and periodic monitoring suffice in most cases. In the rare instance of serious cases, steroid are used to reduce inflammation. Even more rarely, steroid injections and vitrectomy are used to intercede.

The complications related to pars planitis vary extremely according to the severity of the condition. In benign cases, there are none. In mild cases, there can be slight vision loss. In extreme cases, vision loss can be profound, as a result of vitreous hemorrhage and retinal detachment. The use of steroid can lead to cystoid macular edema (vascular hemorrhage) and cataracts, both of which cause vision loss. If administered orally, steroids can also increase the risk of glaucoma, as well as other attendant complications. Treatment of underlying or concomitant autoimmune disorders is recommended, in order to reduce the likelihood of severe complications.

Additional incidental eye complications:

Episcleritis:
Episcleritis is an inflammation of the episclera, or white of the eye. It involves dilation of the fine blood vessels, and will present as a red area on the white of the eye, accompanied by pain and tenderness. Unless it progresses to true scleritis, it does not usually involve vision loss. True acute scleritis is not associated with IBD. Episcleritis generally resolves on its own, as the underlying IBD is brought under control, but topical vasoconstrictors and corticosteroid eyedrops are often used to relieve symptoms.

Keratopathy:
Keratopathy is a corneal abnormality, which occurs in some Crohn's patients, often in association with or as a side effect of, both acute and chronic uveitis. There are many types of keratopathy, and some forms are quite serious, but keratopathy as it relates to Crohn's is primarily benign. It is generally asymptomatic, and presents as white deposits within the edge of the cornea. It causes no pain or visual loss, and usually requires no treatment.

It is recommended that IBD patients, particularly those with a history of other inflammatory conditions, have regular ophthalmic examinations. If you think you may have eye inflammation, please seek appropriate medical advice.

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