How to Prevent and Manage Vision Complications of Crohn's Disease

Eye problems commonly caused by an inflammatory bowel disease (IBD) like Crohn’s can result from the autoimmune disease itself (primary) or from side effects of its treatment (secondary). The tricky part is that these eye issues do not always pop up at the same time you’re having an IBD flare or other intestinal activity.

Uveitis is one of the most common complications of IBD. It happens when the middle layer of the eye — the uvea — gets red and swollen. Symptoms can include pain, redness, sensitivity to light, blurry vision, or seeing floaters. Uveitis usually occurs independently of the intestinal disease. It will not resolve by treating the Crohn’s unless the eye is specifically treated. First line of treatement for uveitis is steroid eye drops and dilating drops. If these are not sufficient to decrease the inflammation, steroid injections are sometimes necessary as well as oral steroids or immunosuppressant medications. If uveitis is not treated, it can lead to a more serious disease called glaucoma.

Glaucoma may occur as a result of untreated uveitis in people who have Crohn’s disease. Chronic inflammation inside the eye can lead to higher pressures inside of the eye and cause glaucoma. In glaucoma, the optic nerve is sensitive to higher eye pressures and can be irreversibly damaged. There is no cure for glaucoma, and sometimes there are no signs or symptoms in the early stages. However, if glaucoma progresses, there can be pain, redness, or blurry vision in the eyes. Medications and surgeries are designed to decrease the eye pressure and prevent the progression of glaucoma.

Scleritis is a painful swelling of the white part of the eye known as the sclera. Symptoms can include a deep red appearance to the eye with severe aching eye pain, tearing, sensitivity to light and possibly vision loss. Treating Crohn’s disease will control symptoms, but drugs or antibiotics can help with pain and inflammation.

Scleromalacia is a rare form of scleritis. People who have scleritis as a result of Crohn’s disease may also develop scleromalacia, which is a thinning of the sclera — the white outer layer of the eye. Signs and symptoms may also include severe pain, decreased vision, a bulging eye, or even retinal detachment. There are medical therapies that treat scleromalacia. However, because scleromalacia can cause vision loss or the complete loss of the eye, graft surgery may be necessary.

Keratopathy is diagnosed when a person has calcium deposits on the cornea — the clear protective layer of the eye. Although Crohn’s keratopathy is rare, small grey deposits can form in different layers of the cornea. It is not painful nor does it lead to vision loss. Keratopathy usually resolves on its own as Crohn’s disease is treated. A second type of keratopathy is called band keratopathy and occurs when calcium deposits on the cornea and causes an opaque layer over the cornea. This type of keratopathy causes a foreign body sensation and can cause a decrease in vision. People with Crohn’s disease may develop keratopathy as a result of IBD or as a result of scleritis.

Episcleritis occurs when the outer layer of the white of the eye — the episclera — is inflamed. Symptoms can present with redness and mild discomfort. More severe pain is usually associated with scleritis and light sensitivity tends to occur with uveitis. Episcleritis resolves on its own when Crohn’s disease is treated, but the symptoms can be treated with steroid eye drops and other topical medicines.

A cataract is the clouding of the eye’s lens. Most cataracts are age-related and develop gradually, but people with Crohn’s disease can develop cataracts as a result of taking oral steroids to treat their Crohn’s disease. This is called secondary cataract. Common symptoms of cataracts are cloudy vision, faded colors, glare, poor night vision, and double vision. In the early stages of cataract, special eyeglasses can improve vision. If that doesn’t work, the cataract may have to be surgically removed.

People with Crohn’s disease have a high prevalence of vitamin A deficiency. Without enough vitamin A, a person can develop dry eye disease. Dry eye disease is a condition where a person doesn’t have enough tears to moisten the eye, or produces tears that are of poor quality. Dry eye symptoms can include burning, blurred vision, and a feeling that something is in the eye. Eye drops are available that increase tears, lubricate the eye, or control inflammation. Severe vitamin A deficiency can lead to night blindness.

The best way to prevent eye complications as a result of Crohn’s disease is to develop a successful treatment plan with your doctor to manage your IBD. See your eye doctor regularly to detect trouble early, as early treatment is the best way to maintain healthy vision.