Although Crohn’s Disease is known for causing digestive problems, it can also affect other areas of your body. Individuals with Crohn’s may experience skin complications, joint pain, and eye problems. About 10 percent of individuals with Crohn’s have problems with their eyes at some point.
The exact cause of eye problems is not clear. However, we know that eye tissue is susceptible to inflammatory problems caused by inflammatory bowel disease. Crohn’s Disease symptoms that appear outside the gastrointestinal tract are known as extra-intestinal manifestations, and occur in 25-40 percent of individuals with inflammatory bowel disease. The risk of developing eye problems increases when you have at least one other extra-intestinal manifestation of Crohn’s. Alternatively, eye problems may be side effects of Crohn’s Disease medications. Discuss new symptoms such as vision issues with your doctor.
Eye Problems Linked to Crohn’s Disease
Episcleritis is inflammation in the episclera, the tissue between the clear outermost layer of the eye and the white part of the eye, the sclera. This condition causes inflammation in the eye’s tiny blood vessels, which causes redness in the sclera. Other symptoms include tenderness, watery eyes, and pain. Episcleritis does not cause blurred vision or light sensitivity as other conditions do. While this eye problem is the most common Crohn’s Disease eye issue, it is less painful than other associated eye problems. Episcleritis is often present before, or at the time, Crohn’s disease is initially diagnosed.
Scleritis is inflammation of the sclera (the white part of the eye). This condition causes watery eyes, redness, pain in and around the eye, burning, blurred vision, headaches, difficulty sleeping, and sensitivity to light. The sclera gives the eye its shape, and in severe scleritis cases, the sclera can begin to thin over time.
Uveitis is inflammation in the uvea, the eye layer just below the sclera that includes the iris, the colored part of the eye. Uveitis symptoms include redness, pain, blurred vision, and sensitivity to light. Symptom onset may be rapid or may slowly develop over time. This condition is less common than episcleritis, but more serious. Uveitis may lead to glaucoma or vision loss if not treated. This condition is four times more common in women than men, and associated with other extra-intestinal manifestations including arthritis and problems with the sacroiliac joint.
Keratopathy causes blister-like swelling in the cornea, the clear outer part of the eye. It appears as tiny white deposits at the edge of the cornea, which can be seen by your ophthalmologist. Symptoms include irritation, excess tearing, discharge, sensitivity to light, and feeling as if something is stuck in the eye.
Dry eyes, formally known as keratoconjunctivitis sicca, are caused by decreased tear production. Symptoms include redness, stinging, itching, burning, pain, and feeling as if something is stuck in the eye. Dry eyes may alternatively be caused by vitamin A deficiency. If so, your doctor may recommend taking a vitamin A supplement to correct the deficiency and alleviate the symptoms.
Optic neuritis is rarely seen with Crohn’s Disease but is a possible complication. The optic nerve communicates with the brain and translates the light and color your eyes take in into the objects your brain sees and recognizes. When your optic nerve is inflamed or irritated you may experience poor vision, blurry vision, trouble seeing out of one eye, pain when moving your eye, and seeing colors less vividly. If left untreated, optic neuritis may lead to permanent eye damage.
Treating Eye Problems
Seeing your doctor for a visual examination is the first step in treating eye problems associated with Crohn’s Disease. Your doctor will use a variety of tools including special lights, microscopes, and drops to identify which part of your eye is affected.
Different conditions require different treatments.
- Episcleritis is treated with cold compresses or topical steroids to relieve inflammation.
- Scleritis is treated with eye drops or oral medications.
- Uveitis is treated with topical or systemic steroids to clear inflammation, or medications to dilate the pupil.
- Keratopathy is treated with lubricating fluid or gel. If the condition does not resolve, prescription eye drops are used.
- Dry eyes are treated with eye drops or warm compresses.
- Optic neuritis may resolve on its own, but if it does not, IV medications, injections, and steroids are all treatment options.
In general, treating Crohn’s disease and reducing inflammation will also alleviate eye problems. Additionally, avoiding Crohn’s flares also reduces the risk of developing eye problems in the future. To lower your flare risk and subsequent eye problems avoid excess alcohol, caffeine, smoking, and non-steroidal anti-inflammatories, and manage your stress level. Consistent follow-ups with your doctor to manage your Crohn’s disease and an eye specialist to identify any eye problems early is best for your overall health.
Working with a dietitian or nutritionist to maintain remission and avoid flares is another great way to optimize your overall health.
Kaitlyn Willwerth is a Registered Dietitian at OnPoint Nutrition. Kaitlyn's work focuses on providing individualized health and lifestyle coaching and, most importantly, support. She is a Certified LEAP Therapist and has also completed the Monash University 'Low FODMAP Diet for IBS' online training course for health professionals.