Ocular Insights: Exploring Uveitis as a Manifestation of Celiac Disease

Celiac disease (CD) is an autoimmune condition that mainly affects the small intestine and often leads to issues with nutrient absorption. People with CD commonly experience symptoms like diarrhea, bloating, stomach pain, fatty stools, unintended weight loss, and low iron levels. In addition to its intestinal manifestations, CD is also associated with a range of extraintestinal features and comorbid conditions. Although uveitis is a rare manifestation of CD, we report, to our knowledge, the first documented case from Pakistan of posterior uveitis secondary to CD in an 11-year-old girl. The patient presented to the OPD with complaints of a gradual, painless loss of vision in both eyes over a four-month period. Notably, she exhibited no associated ocular, GI, or malabsorptive symptoms. On examination, her best-corrected visual acuity was 6/24 in the right eye and hand movement only in the left eye. Ocular findings included bilateral +1 anterior chamber cells without keratic precipitates, posterior synechiae, or iris nodules. The anterior segment inflammation was accompanied by bilateral vitritis, vasculitis, choroiditis, and optic disc atrophy. A multidisciplinary team was assembled to rule out other potential causes of uveitis and to develop a treatment plan. Despite oral and topical corticosteroids, there was no significant control of intraocular inflammation. Immunosuppressive therapy was initiated, but disease progression continued, ultimately resulting in complete vision loss. Typically, children with CD who present with classic symptoms, such as bloating and diarrhea, are promptly diagnosed and treated. However, patients without these hallmark intestinal symptoms may remain undiagnosed, potentially leading to irreversible complications like severe vision loss. This case, along with previous reports in the literature, highlights the importance of considering CD in the differential diagnosis of uveitis, even in the absence of GI symptoms, particularly in patients who are unresponsive to standard steroid therapy and after exclusion of other known causes of uveitis.