Managing IBD outside the gut: ocular manifestations

Area of Science:

• Ophthalmology
• Gastroenterology
• Rheumatology

Background:

• Extraintestinal manifestations (EIMs) are frequent in inflammatory bowel disease (IBD), affecting over 25% of patients.
• Ocular complications occur in approximately 10% of IBD cases and can precede gastrointestinal symptoms.
• Therapeutic interventions for IBD, including steroids and 5-aminosalicylic acid, can lead to secondary ocular issues.

Purpose of the Study:

• To review the spectrum of ocular complications associated with inflammatory bowel disease (IBD).
• To discuss the pathogenesis, clinical presentation, and management of IBD-related ophthalmic conditions.
• To emphasize the importance of routine ophthalmic evaluation in IBD patient care.

Main Methods:

• Review of existing literature on ocular manifestations in inflammatory bowel disease (IBD).
• Analysis of reported ophthalmic complications, their association with disease activity, and treatment responses.
• Discussion of pathogenetic factors and clinical correlations between intestinal and ocular inflammation.

Main Results:

• Conjunctivitis, episcleritis, scleritis, and uveitis are the most prevalent ocular complications.
• Anterior uveitis is the most common severe ocular manifestation, particularly in women, often presenting as mild and nongranulomatous.
• Posterior segment involvement, including optic neuropathy and vasculitis, can also occur.

Conclusions:

• Ocular inflammation and gut inflammation in IBD are not always correlated.
• Topical or systemic steroids are typically effective for anterior segment inflammation; immunosuppressants are considered for refractory cases or steroid intolerance, especially in HLA-B27-positive patients.
• Routine ophthalmological assessment is recommended for all patients diagnosed with inflammatory bowel disease (IBD).