Extraintestinal Manifestations of Inflammatory Bowel Disease: Focus on the Musculoskeletal, Dermatologic, and Ocular Manifestations

Paul E. Evans, MD; Darrell S. Pardi, MD


March 19, 2007

Ocular Manifestations

Ocular manifestations of IBD should be considered in patients presenting with tearing, burning, itching, pain, or vision changes. Eye complications occur in approximately 3% of patients with IBD, and are more frequent in ulcerative colitis than in Crohn's disease.[3,25] The major eye complications include episcleritis, scleritis, and uveitis.[31] Episcleritis is inflammation of the vascular layer directly beneath the conjunctiva that presents with acute redness of 1 or both eyes, with burning, itching, and pain to palpation (Figure 3). Scleritis is a more serious disorder, and is caused by inflammation of deeper scleral vessels; it presents with redness and pain, and may involve vision changes (Figure 4). Uveitis includes inflammation of the iris, vitreous, choroids, or retina. Patients typically present with acute redness, pain, and vision changes.

Figure 3.

Episcleritis .(Courtesy of Mayo Clinic Department of Ophthalmology)

Figure 4.

Scleritis. (Courtesy of Mayo Clinic Department of Ophthalmology)

IBD patients who present with the symptoms described above should be suspected of having 1 of these common ocular complications. Patients with significant symptoms or any vision changes should be referred immediately to an ophthalmologist. These conditions usually respond well to treatment of the underlying bowel disease. Patients with episcleritis may also respond to topical steroids. Scleritis and uveitis are more likely to respond to systemic treatment and should be managed in conjunction with treatment by a specialist.[31]


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