How Does Crohn’s Affect the Eyes?

The inflammation that occurs in Crohn’s disease can show up in the eyes, leading to a handful of fairly common but largely treatable eye disorders.

Crohn’s disease is most commonly recognized by its characteristic gut inflammation and digestive symptoms. However, inflammation in people who have Crohn’s can affect other parts of the body.

Medical professionals refer to Crohn’s symptoms elsewhere in the body as extraintestinal manifestations (or EIMs). One area in particular where you might not expect to have an EIM is in the eyes.

In fact, ophthalmic inflammatory disorders occur in 3.5–6.8% of people with Crohn’s.

In most cases, though, eye problems in Crohn’s are treatable. But it’s important to act quickly when you notice changes to your eyes or vision.

If left untreated, some of the most common eye problems found in people with Crohn’s can lead to much more dangerous issues and even cause permanent vision loss. Be sure to schedule regular vision exams and check in with an eye doctor whenever you experience vision or eye symptoms.

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What is the connection between Crohn’s disease and eye problems?

The reasons why people with Crohn’s sometimes develop eye conditions are not fully understood. But one leading theory suggests that the body mounts an immune response against toxins and pathogens that enter the bloodstream from the damaged GI tract. This may prompt inflammation all over the body — including the eyes.

While some eye problems can occur as a natural EIM of Crohn’s disease, they can also be triggered by some medications used to treat IBD. One example is systemic corticosteroids, which are associated with an increased risk of cataracts and glaucoma.

A large analysis from 2006 also suggests that a family history of IBD could increase a person’s chances of developing eye inflammation issues even without a diagnosis or symptoms of IBD.

These eye conditions are also more common in people who are assigned female at birth or who have arthritis or arthralgia as well as Crohn’s.

What kinds of eye problems does Crohn’s disease cause?

A handful of inflammatory eye conditions appear to be common in people with Crohn’s disease:

Episcleritis

Episcleritis is the most common ocular manifestation related to Crohn’s disease.

Around 2–5% of people with Crohn’s will develop this benign inflammation of the episclera, a thin layer of tissue that covers the white layer of the eye, the sclera.

People with episcleritis will notice redness in one or both eyes. It might look like conjunctivitis or “pink eye,” and you might experience mild discomfort or no pain at all. There can also be inflammation surrounding the blood vessels on the surface of the eye. It usually does not impact vision capacity.

This eye condition can pop up during Crohn’s flares or any other time. It’s often resolved easily with treatment, but even so, episcleritis can sometimes come back. It might even spread to the sclera in time, causing another eye problem associated with Crohn’s disease, scleritis.

Scleritis

Though somewhat rarer than episcleritis, scleritis is more dangerous. It causes inflammation in the sclera itself, rather than the tissue covering it.

It can cause moderate to severe pain, radiating from the face to the scalp, and can worsen at night.

To most of us, the outward symptoms of these two conditions — redness and swelling — would look the same. An ophthalmologist would need to examine with a slit lamp to distinguish between the two eye issues. They would also know that episcleritis will often not include light sensitivity, blurring, and low vision like scleritis would.

Uveitis

Uveitis affects 1.5–11% of people with Crohn’s disease.

This condition involves inflammation of the uveal tract, the middle layer of the eye. Uveitis is divided into four types depending on its location:

• anterior
• intermediate
• posterior
• panuveitis

Common symptoms include eye pain, blurred vision, sensitivity to light, and headaches. In Crohn’s disease, anterior uveitis is the most common form and may also result in a pocket of pus at the front of the eye.

Dry eye disease

Another type of eye condition seen in people with Crohn’s is dry eye disease.

A study from 2010 found a correlation between dry eyes and taking 5-aminosalicylates as a treatment for IBD. This condition, like the name suggests, leaves the eyes without sufficient tears or without the proper components within the tears to effectively lubricate the eyes.

How are Crohn’s-related eye problems diagnosed?

Sometimes, eye inflammation symptoms can occur even before intestinal inflammation and before a diagnosis of Crohn’s.

For that reason, if you notice signs of eye inflammation, you should contact an ophthalmologist ASAP for an eye exam.

If you have not yet been diagnosed with Crohn’s and are diagnosed with one of these eye conditions, consider setting up a screening appointment with a healthcare professional. If you do have Crohn’s, be sure to mention that you have the condition when you see your eye doctor so that they can examine your eyes for signs of any common Crohn’s-related eye issues.

Your eye doctor should also ask about the medications you are currently taking, but if not, be sure to mention those as well. They will most likely ask about any symptoms you’re experiencing, such as pain or sensitivity to light.

The ophthalmologist may then use a slit lamp to look for evidence of inflammation. They will also likely test for dryness and changes to your vision.

Treatment options

If you develop any of these Crohn’s-related eye conditions, it will be important to follow the steps your doctor suggests. Often, treating the primary Crohn’s symptoms with changes to diet or lifestyle can help to decrease or eliminate any inflammation that occurs in the eyes.

However, you may also need to add or change a medication, or your eye doctor may recommend some home-based treatments, such as the following:

For episcleritis

Treatments can range from cool compresses and lubricating eye drops to topical nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes, topical corticosteroids (in the form of eye drops) are required.

For scleritis

Topical anti-inflammatory agents like dexamethasone eye drops or systemic corticosteroids likely will be required.

For uveitis

For mild uveitis cases, topical corticosteroids could work. But for more severe cases, systemic corticosteroids or anti-TNF agents could be necessary to reduce inflammation. Topical cycloplegics may be needed to prevent spasms related to pain.

Additionally, immunosuppressive therapy may be necessary for any prolonged use of corticosteroids.

If left untreated, uveitis can cause permanent vision loss. It’s the third leading cause of irreversible blindness in developed countries.

Dry eye

Treatments range from lubricating eye drops and warm compresses to omega-3 supplements.

The takeaway

Knowing the signs and symptoms of eye disease can make all the difference, just like with Crohn’s symptoms elsewhere in the body and the digestive system.

We don’t always think about inflammation in the eyes when we consider Crohn’s symptoms, but the fact is that this disease can cause inflammation in many places besides the digestive system. While eye issues associated with Crohn’s are often mild and easily treated, there is a risk of vision loss if these conditions go untreated.

Pay attention to changes to the ways your eyes look and feel, as well as changes to your vision. If your eyes look pink, feel uncomfortable, or become excessively dry, these are good signs that it’s time to book an appointment with an eye doctor.

You only have one pair of eyes, so watch out for them like they watch out for you.

FAQs

Can eye problems be an early sign of Crohn’s?

Yes. Take note of any eye symptoms because these eye issues can occur even before digestive symptoms arise in Crohn’s disease.

Will I lose my vision because of Crohn’s-related eye problems?

Although rare, it is possible to lose your vision in cases where scleritis and uveitis are left untreated for long enough. That’s why it’s so important to speak with your doctor or ophthalmologist right away if you see pinkness, eye sensitivity, dry eyes, or experience any eye discomfort.