What Everyone With UC Needs to Know About Their Eyes
How can abdominal pain and inflammation be related to the health of your eyes? For some people, there’s a direct connection. Approximately 10% of those with ulcerative colitis (UC)—an inflammatory bowel disease (IBD) that causes tiny open sores, or ulcers, inside the lining of the colon—also have eye pain, vision problems, light sensitivity, and, in rare cases, permanent vision loss when either their UC or the related eye condition is left untreated. Read on to learn about the most common eye problems associated with UC.
Eye disorders associated with UC are known as “extraintestinal complications,” which simply means they show up outside of the digestive tract, says Eugene F. Yen, M.D., clinical director at the Center for Crohn’s and Colitis at the NorthShore IBD Center in Evanston, Ill. If you have UC, your gastroenterologist should keep close tabs on your eye health. “If your UC isn’t under control, you’re more likely to experience eye problems,” Dr. Yen says. “We always ask questions about eye health—whether you’re experiencing any pain, blurred vision, or sensitivity to light—even if you’re doing well from a GI standpoint.”
Which Comes First: UC or Eye Problems?
If your gastroenterologist notices any eye issues during a checkup, he or she will refer you to an ophthalmologist, a doctor who specializes in diseases of the eye. The two specialists then work together to coordinate treatment for any UC-related eye conditions. However, sometimes an ophthalmologist spots an issue first. “It’s less common, but sometimes eye inflammation, eye pain, or blurred vision is the first UC symptom someone seeks treatment for,” says Milan Shah, M.D., clinical spokesperson for the American Academy of Ophthalmology. “Some patients don’t know they have UC—they were never diagnosed until they came in with eye problems.”
UC Eye Symptoms Are Hard to Ignore (and That's a Good Thing)
Typical UC symptoms, including abdominal pain or diarrhea, can come on gradually, so some people may ignore them at first, says Dr. Shah. “Gastrointestinal (GI) symptoms are sometimes written off as a reaction to eating something bad or having a virus or food poisoning,” he says. “But problems with the eyes get everyone’s attention. It’s so uncomfortable you can’t ignore it.” If you think you have any of the following symptoms or conditions, you know what to do: High-tail it to your eye doc today.
Episcleritis: Uncomfortable But Not Worrisome
This condition is one of the most common associated with UC and IBD, says Dr. Shah. Episcleritis is inflammation of the episclera, which is the connective tissue between the sclera (the white part of the eye) and the conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids). This condition can cause redness, pain, and tenderness in the eyes, Dr. Shah explains, adding that you may also feel the sensation that something is in your eye. Your doctor may prescribe steroid eye drops, but episcleritis often resolves on its own in a few weeks.
Scleritis: Both Serious and Painful
Scleritis causes inflammation, pain, and redness in the white part of the eye (the sclera), which may develop gradually but eventually become severe, says Dr. Shah. The redness may have a purple-ish hue, and the eye may become teary and very sensitive to light. Treatment includes steroid eye drops and nonsteroidal anti-inflammatory drugs (NSAIDs). If left untreated, scleritis can lead to perforation of the eyeball, which can cause permanent loss of vision. If you have UC and your eye feels red and painful, call your doctor immediately.
Anterior Uveitis: Caused by Trauma or Inflammation
Anterior uveitis, also known as iritis, is inflammation of the middle layer of the eye, which includes the iris (the colored part of the eye) and surrounding tissue. This condition is often connected to autoimmune disorders or inflammatory diseases such as UC, Dr. Shah says, or sometimes trauma. If untreated, it can cause permanent loss of vision. Symptoms include eye pain, redness, blurred vision, and sensitivity to light. Your doctor may prescribe steroid eye drops that dilates the pupils, he says. This helps stop painful spasms in the eye. Most people respond well to treatment, but the condition can reoccur.
Dry Eye Syndrome: Sometimes Linked to Vitamin A Deficiency
Dry eye syndrome is characterized by—you guessed it—dryness, itching, and burning of the eyes. It’s often a secondary problem that can result from an IBD-related vitamin A deficiency, Dr. Shah says. That’s because inflammation in the small and/or large intestine—common in IBD—can inhibit the absorption of this vitamin from food. Still, dry eye isn’t always linked to UC, Dr. Shah adds. If you have symptoms, talk to your doctor. He or she can confirm a diagnosis and suggest the best solution for you, which may involve using artificial tears or taking vitamin A supplements.
Keratopathy: A Disease of the Cornea
The cornea is your eye’s clear, protective outer layer. Along with the sclera, it serves as a barrier against dirt and germs. Keratopathy is a rare disease of the cornea that can occur in people with IBD or other systemic diseases. Symptoms include eye pain, the sensation that something is in your eye, and, occasionally, decreased vision, Dr. Shah says. Small, white calcium deposits show up on the cornea, which your ophthalmologist will see when examining your eye. The condition does not generally cause vision loss. Treatment includes antibiotic drops, special contact lenses, and steroids—although it may resolve on its own.
Never Ignore Your Symptoms
Eye problems in UC often correlate with disease activity (a flare), so getting your UC under control often helps, Dr. Shah says. “The goal is to treat the underlying disease.” It’s important to communicate with your doctors—both your gastroenterologist and ophthalmologist—and to follow through with any treatments they prescribe. Failing to get proper treatment for UC-related eye conditions can lead to secondary eye problems such as glaucoma or cataracts, Dr. Shah adds. “But this only happens if the condition becomes chronic or recurrent and isn’t properly managed. If these conditions are managed quickly, you’ll avoid secondary problems.”
- Scleritis and Other Diseases: Harvard Health Publishing. (2019). “Scleritis.” health.harvard.edu/a_to_z/scleritis-a-to-z
- UC, IBD, and Eye Disorders (1): World Journal of Gastroenterology. (2017). “Ophthalmic manifestations in patients with inflammatory bowel disease: A review.” mafiadoc.com/world-journal-of-gastroenterology_5c679b7b097c47703d8b46dd.html
- UC, IBD, and Eye Disorders (2): Gastroenterology & Hepatology. (2011). “Extraintestinal Manifestations of Inflammatory Bowel Disease.” ncbi.nlm.nih.gov/pmc/articles/PMC3127025/
- UC, IBD, and Eye Disorders (3): Scientific World Journal. (2015). “Complications of Inflammatory Bowel Disease.” ncbi.nlm.nih.gov/pmc/articles/PMC4386693/