Ocular Manifestations of Inflammatory Bowel Disease

Akshay S. Thomas; Phoebe Lin


Curr Opin Ophthalmol. 2016;27(6):552-560. 

In This Article

Abstract and Introduction


Purpose of review Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) are numerous and can often involve the eye. This review highlights the ocular complications associated with IBD including the critical role the ophthalmologist can play in the diagnosis of IBD, the pathogenesis of IBD, its ocular complications, and the treatment of ocular inflammation associated with IBD.

Recent findings Polygenic and environmental influences, as well as gut microbial dysbiosis, have been implicated in the pathogenesis of IBD. IBD and its EIMs appear to respond well to TNFα-targeted biologics.

Summary IBD is thought to be caused by polygenic and environmental influences, including a dysbiotic gut microbiota. It is a systemic immune-mediated disease with varying types of ocular manifestations that can precede, occur simultaneously, or follow intestinal involvement. The diagnosis of IBD can be confused with other seronegative spondyloarthropathies as well as Behçet's disease. Treatment of IBD-associated ocular inflammation can range from corticosteroids to steroid-sparing immunosuppression such as azathioprine or methotrexate. Refractory disease can respond well to TNFα inhibitors.


Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, is a chronic systemic inflammatory disorder with a predilection for the gastrointestinal tract. Both entities can present with abdominal pain, diarrhea, weight loss, and melena; thus, differentiating ulcerative colitis from Crohn's disease often requires colonoscopic evaluation. IBD is considered one of the spondyloarthropathies (SpAs) along with ankylosing spondylitis (AS), reactive arthritis, and psoriatic arthritis. Extraintestinal manifestations (EIMs) are common in IBD and can often be the presenting symptom. EIMs mainly involve the joints, skin, liver, and eyes.[1–5] Data from the Swiss Inflammatory Bowel Disease Cohort Study revealed that close to 30% of patients with IBD presented with EIMs prior to the diagnosis of IBD.[1] Ophthalmic manifestations can occur in up to 13% of IBD patients.[1–7] Although several EIMs including episcleritis, oral aphthous ulcers, peripheral arthritis, and erythema nodosum, are associated with the degree of intestinal disease activity, other EIMs such as axial spondylarthropathy, uveitis, pyoderma gangrenosum, and primary sclerosing cholangitis do not necessarily coincide with the onset of intestinal symptoms.[5,6] Although ocular complications most often occur following the diagnosis of IBD, they can occasionally be the presenting symptom. Timely detection and diagnosis of ocular manifestations of IBD can lead to earlier diagnosis and management of systemic disease.