Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2017; 23(32): 5836-5848
Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.5836
Ophthalmic manifestations in patients with inflammatory bowel disease: A review
Leandro Lopes Troncoso, Ana Luiza Biancardi, Haroldo Vieira de Moraes Jr, Cyrla Zaltman
Leandro Lopes Troncoso, Ana Luiza Biancardi, Haroldo Vieira de Moraes Jr, Department of Ophthalmology, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Cyrla Zaltman, Department of Internal Medicine, Gastroenterology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Author contributions: Troncoso LL and Biancardi AL performed the literature review and wrote the paper; de Moraes Jr HV critically revised the article and provided photos; Zaltman C provided expertise and critical revision of the manuscript for important intellectual content; all authors approved the submitted version of the manuscript.
Conflict-of-interest statement: The authors report no conflict of interest regarding the publication of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Leandro Lopes Troncoso, MD, Department of Ophthalmology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil. leandroltroncoso@ufrj.br
Telephone: +55-21-988878988 Fax: +55-21-33115645
Received: June 7, 2017
Peer-review started: June 8, 2017
First decision: June 22, 2017
Revised: June 29, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: August 28, 2017
Processing time: 81 Days and 7.2 Hours
Abstract

Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Ocular complications, Eye manifestations

Core tip: Among all inflammatory bowel disease (IBD) patients, ophthalmic inflammatory disorders occur in 0.3% to 13.0% of cases, 1.6%-5.4% among the ulcerative colitis and 3.5%-6.8% among the Crohn’s disease patients. Since asymptomatic inflammation of ocular tissues may occur, a routine ophthalmic follow-up is recommended in all IBD patients, mainly before changes in IBD therapy because some drugs may cause ocular adverse effects. Patients with chronic or recurrent use of systemic corticosteroids should be warned of the risk of cataracts and glaucoma. Patient awareness of possible eye involvement is important in improving understanding of their disease and health outcomes, supporting early diagnosis, which will contribute to success of the treatment.