Watch your eyes - extraintestinal manifestation of the eyes in case of ibd

My dear patients  !

To have many ideas is nice, but when it ends up in starting to write on three articles more or less at the same time, it doesn`t make things easier. Finally this article was the one with the most clear cut issue and so the easiest to finish.

Lately in my IBD consultation hour: 

“Did you have ever problems with your eyes ?”

“?!”

“Ichting ? Aking ? Loss of view?”

Hah ! Yes, this is definetly the IBD information-Blog I.M. INFORMATION MATTERS.  And today on the issue of another  concomitant disease or better: extraintestinal manifestation  (EIM) of the inflammatory bowel diseases Crohn`s disease and ulcerative colitis. In particular EIM of the eyes.

Rather rare but as a matter of fact the eyes can be involved in case of IBD, inflammatory bowel disease. The inflammation shifts from the intestine to another organ. Basicly the same as in

…the joints (arthritis, and spondylarthrosis, as you can read in the article on arthritis in this blog)

…the bile ducts (PSC, primary sclerosing cholangitis –  you can read about that on this blog as well)

…the skin (Erythem anodosum, pyoderma gangraenosum, Acne inversa and others … still missing in this blog but surely to come soon)

Affection of the eyes in case of IBD is rare, I wrote it above. It is more common in Crohn`s disease than in ulcerative colitis. Women are affected more often than men (and at the same time the few patients I know with a manifestation on the eyes are men). About 2% to 5% of IBD patients are affected and get an EIM of the eyes. It is not as common as an affection of the joints. Yet it is more common than affection of the bile ducts (wich means PSC, primary sclerosing cholangitis).

I write that in order to give you an idea, what to expect or not to expect. But of course all of this: who is affected – is it Crohn`s disease ? ulcerative colitis ? women ? men ? old ? young ? … is ok für the summary but it actually doesn`t change anything  for the individual. And what`s interesting for you is your personal situation. …

Tell your opthalmologist you have IBD...

It is possible that many of you read this and think : eyes ? not my problem !

But maybe you read this and think something like: Hah ! If it was that easy ! For me it startet 10 years ago with the ongoing inflammation of the eyes and I was diagnosed with Crohn`disease just 3 years ago. 

Affection of the eyes might temporally precede the intestinal inflammation. And often there are years between the diagnose of the one and diagnose of the other.

In general and right away: in case you do have an inflammatory bowel disease, Crohn`s disease or ulcerative colitis and recoginze changes regarding your eyes, go see an opthalmologist. Itching, red eyes, deterioration of the visus it should all be checked by a specialst.

And tell the opthamolologist that you do have an IBD !

On the “why ?”: there are theories, reasonable theories, but the mechanisms  why an inflammation that  has it`s origin in the intestine affects the eyes are yet not  completely understood.  

It is assumed that antigens (particles that are not familiar to the body  and therefore cause inflammation) are dislocated from the intestine into the eyes and than lead to inflammation – as they do in the intestine. 

It is assumed that there might be similar structures of molecules in the epithelial cells in the mucosa and in other regions of the body, so the inflammatory cells that recognize these structures act in te same way in case they recognize them – for example in the eyes.

There is the theory that inflammatory cells, the lymphocytes, that are responsible for inflammation and keep it running, carry inflammation from the intestine in other parts of the body.

Genetics seem to play an important  role for extraintestinal manifestation as well. Patients with extraintestinal manifestation of the eyes seem to have certain genes in common. 

What do you recognize...:

For you it is certainly important, what you recognize when you have an extraintestinal manifestation of the eyes in case of IBD, Crohn`s disease and ulcerative colitis. And even though the eye seems to be a rather small organ (let`s say in comparsion to the gut) yet it is complex enough so that there are 3 forms of extraintestinal manifestation of the eye. I will write the names now (and as you all know, here on this blog I.M. INFORMATION MATTERS not to annoy you with weired words but in order to let you know the terms so you don`t  to miss out on the conversation with your doctor because you are confused by terms): 

episcleritis

scleritis

and uveitis.

(these terms arn`t that bad, are they ? But in case one or the other of you is wondering where these names come from … pretty much as always in medicine. The term describes , where inflammation happens or even better in this case -which part of the eye is inflamed.) 

The most common is episcleritis. Episcleritis (inflammation of a certain tissue in the eye) is rather harmless, you will recognize itching and a reddened eye. That is indeed not very specific, right. But in case you have these symptoms you will probably recognize that acitivity of episcleritis is linked to the activity of the intestinal inflammation. So when your gut starts to cause problems and at the same time you recognize itching  and reddened eyes – go see the opthalmologist.

The two other EIM (extraintestinal manifestation) of the eyes  in case of IBD are less common. scleritis and uveitis. Both terms describe as I mentioned that there is inflammation in a certain tissue or certain “layer” of the eye.

Different fron episcleritis these extraintestinal manifestations cause pain, the eyeball is painfull on palpation or movement. Scleritis and uveitis both can cause deterioration of the vision. Uveitis can lead to complete loss of sight.

What to do ... ?

Ok. so what to do in case of inflammation of the eyes related to IBD, Crohn`s disease or ulcerative colitis ?

Go see the ophthalmologist.

What does the ophthalmologist do ?

I am not an ophthalmologist. But it is always a medical therapy.  And what kind of medical therapy is varying accoridng to – of course –  which of the 3 EIM episcleritis, scleritis, uveitis needs to be treated and it depends on the severity of manifestation. I wrote above that episcleritis correlates in its activity with the activity of the inflammation of the intestine. And the “good thing” about that is that the symptoms of the eyes will improve when the inflammation in the gut is under controll.

Sometimes topical steroids are used – means cortison containing eye drops. In case of scleritis and uveitis there is need for stronger therapy and that means systemic therapy. Steroids as a tablet or other therapies, that are suppressing the immune system on a systemic level, certain biologics are one option. Especially in case of uveitis it is important, that therapy is initiated soon to avoid permanent visual deterioration.

Requires that you see the ophthamlologist. I cannot emphazise that enough.

Then – chances of recovery with proper treatment are good. Fortunately. It is so important that everybody has these extraintestinal manifestations (EIM) of the eyes in mind so that there is no delay in diagnostics and therapy. And that is also the reason why I thought information on this rare but yet important EIM in case of IBD is important for you to have.

And with that – take care everybody !

 

best regards

 

Dr. med. Susanne Weyrauch

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