Ophthalmic Complications in Inflammatory Bowel Disease

Abstract

The prevalence of inflammatory bowel disease (IBD), estimated at 843 per 100,000 people (95% PI 828-859) (i.e., 0.843% of the population) in 2023 is increasing in Canada and is expected to reach 1.1% of the Canadian population by 2035. Consequently, extraintestinal manifestations and complications will also increase. Up to 50% of patients suffering from IBD will develop an extraintestinal manifestation (EIM) during the course of their disease, patients with Crohn’s disease (CD) being more often affected then those with ulcerative colitis (UC). Ocular manifestations are the third most common EIM after articular and dermatological involvements. Ocular complaints in patients with IBD can represent an EIM, a complication of systemic treatment or an unrelated affection. All patients presenting with a red eye, light sensitivity, loss of vision or any acute ocular symptom(s) should be promptly evaluated by an eye specialist. Early detection of ophthalmologic diseases and appropriate management require collaboration between specialists and are of utmost importance to avoid permanent visual loss.  The most common ocular manifestations reported in IBD patients are episcleritis (2-5%) and anterior uveitis (0.5-3.5%). Other less common manifestations include scleritis, intermediate and posterior uveitis, retinal vasculitis, retinal vascular occlusions, orbital inflammatory syndrome, and optic neuritis. Ocular manifestations can also be associated with malabsorption syndromes encountered in some patients with IBD. Secondary vitamin A deficiency can result in night blindness and keratoconjunctivitis sicca.