Complications and Extraintestinal Manifestations

What is episcleritis?

This is a type of red eye where there is inflammation of the episcleral tissues. These are tissues between the whites of the eyes and the lining of the inner eyelids. 

Episcleritis is the most common eye complication associated with IBD. Symptoms include red and sore eyes. There is usually no vision loss. Episcleritis is considered an indicator of active IBD. 

Treatment of episcleritis

Treatment of IBD inflammation, usually with infliximab, is effective in managing episcleritis. However, this condition can also be treated with artificial tears, topical NSAIDs, or topical steroids.

What is scleritis?

This is a severe, painful inflammation of the whites of the eyes (the sclera). It generally occurs in older patients than episcleritis. Scleritis can seriously reduce your vision and needs urgent attention. It is rare in IBD. 

Repeated episodes of scleritis can lead to a more serious condition called scleromalacia. It can also cause thinning of the sclera, which can cause a tear. 

Treatment of scleritis

Aggressive control of the underlying IBD inflammation can help reduce recurrence of scleritis.

What is keratopathy?

This is a blister-like swelling of the cornea, which is the transparent front part of the eye. Keratopathy is rare in IBD. 

Symptoms include light sensitivity, blurred vision, and a feeling like something is in the eye. It may or may not cause eye redness. 

Treatment of keratopathy

Systemic immunosuppressants to manage the inflammation of IBD is usually enough to treat keratopathy.

What is uveitis?

This is a group of diseases causing inflammation of structures inside the eye. In IBD, the most common type of uveitis affects the iris of the eye, which is the circular coloured part. This type of uveitis is called iritis. 

Symptoms include red, irritated eyes with light sensitivity, blurred vision, or headache. 
Unlike episcleritis, scleritis, and keratopathy, uveitis/iritis symptoms do not seem to correlate with active IBD flare.

Uveitis/iritis is more common if you also have a skin complication of IBD called erythema nodosum, as well as with joint pain.

Treatment of uveitis

Treatment usually involves topical steroids or, rarely, systemic steroids or immunosuppressants. Iritis should be assessed urgently.

Cataract formation results in ‘clouding’ of the eye or blurred vision. Cataracts may be caused by steroid medications. The treatment of cataracts may require a change in IBD medication. 

Dry eyes can occur due to vitamin deficiencies caused by IBD. Supplements may be helpful.