Sunday, November 17, 2013

Backdoor to your Soul

Eyes and IBD

One of the lesser known extraintestinal impacts of Crohn’s Disease and Ulcerative Colitis is on the eyes.  Because of the potential impact on vision, those with IBD should make sure they see an eye doctor for a regular exam (annually) to baseline and then monitor their vision.  In addition to the diseases themselves, certain drugs used to treat IBD have a negative impact on vision long-term.  Understanding the risks can assist in early detection of problems and intelligent choices in medication.
Overall ocular inflammation is much higher in IBD than in the general population.  The estimated rate of occurrence is currently between 4% and 12% of IBD sufferers that develop ocular manifestations.(1)  The two primary categories of inflammation not related to drugs are uveitis and scleritis.  A small study showed a much higher incidence of both occurring with colonic involved disease than with isolated small bowel disease, finding that “Patients with colitis or ileocolitis were more likely to suffer from ocular inflammation (23.9%, 17 of 71), than patients with small bowel involvement alone (2.8%, 1 of 36) (P = 0.013)”. (2)
Amongst the extraintestinal manifestations of IBD, iritis and uveitis are the most common, with 2.2% of women and 1.1% of men experiencing the issues.  They are most common in ulcerative colitis sufferers, with a rate of occurrence of 3.8% in women with UC.  These are actual IBD manifestations, as opposed to co-morbid diseases like asthma.  Uveitis is an often painful inflammation of the uvea, or middle structures of the eye.  Iritis is really anterior uveitis – the iris is part of the uvea – but is sometimes tracked separately.  Uveitis can result in blurry vision, light sensitivity, and redness in the eye.  Use of entanercept (Enbrel) was associated with an largely increased chance of uveitis occurring (beyond that of IBD in general), whereas infliximab (Remicade) and adalimumab (Humira) showed no increase in uveitis.(3,4)
Episcleritis and scleritis are an inflammation of the outer, white area of the eye.  Episcleritis is less severe in general, and both are treatable.  Though occurring at a higher rate in IBD, one of the primary treatments for both is the use of Infliximab, which has been shown to have a positive anti-inflammatory effect on the conditions.(5)
One of the biggest concerns for eyes and IBD comes not from the disease but from its treatment.  Prednisone use has been shown to greatly increase the risk of developing glaucoma through an increased Intraocular Pressure (IOP).  Specifically, a portion of the population is genetically susceptible to increased IOP through the use of steroids, potentially as high as one third.  The increased IOP causes nerve damage, and can eventually lead to blindness.(6)
The eyes are an often overlooked area for IBD to manifest itself.  Anyone with Crohn’s, especially Crohn’s Colitis, or with Ulcerative Colitis should get annual eye exams from a licensed optometrist or ophthalmologist.  Additionally, because an increased IOP can have rapid and irreversible impact, any eye issues should be treated as a medical emergency and evaluated immediately by a physician.

Bottom Line

·         Eye issues affect approximately 10% of those with IBD, and up to 20% of those with colon involvement.
·         All of eye issues can progress to glaucoma and potentially blindness.  Any eye problems that manifest should be treated as a medical emergency.
·         Yearly visits to your optometrist or ophthalmologist should be considered a regular part of your preventative care regimen. 
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1.       Manganelli, C., S. Turco, and E. Balestrazzi. "Ophthalmological aspects of IBD." Eur Rev Med Pharmacol Sci 13, no. Suppl 1 (2009): 11-13.
2.       Salmon, J. F., J. P. Wright, and A. D. Murray. "Ocular inflammation in Crohn's disease." Ophthalmology 98, no. 4 (1991): 480-484.
3.       Bernstein, Charles N., James F. Blanchard, Patricia Rawsthorne, and Nancy Yu. "The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study." The American journal of gastroenterology 96, no. 4 (2001): 1116-1122.
4.       Lim, Lyndell L., Frederick W. Fraunfelder, and James T. Rosenbaum. "Do tumor necrosis factor inhibitors cause uveitis? A registrybased study." Arthritis & Rheumatism 56, no. 10 (2007): 3248-3252.
5.       Mintz, Roni, Edward R. Feller, Robert L. Bahr, and Samir A. Shah. "Ocular manifestations of inflammatory bowel disease." Inflammatory bowel diseases10, no. 2 (2004): 135-139.

6.       Tripathi, Ramesh C., Sunil K. Parapuram, Brenda J. Tripathi, Yong Zhong, and K. V. Chalam. "Corticosteroids and glaucoma risk." Drugs & aging 15, no. 6 (1999): 439-450.

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