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Why patients with inflammatory bowel disease might need to see their ophthalmologist

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Ocular involvement in IBD is a rare extraintestinal manifestation, but may be critical because of its potential sight-threatening complications if not treated promptly and accurately, according to researchers.

Polish investigators who conducted a review of the occurrence of ophthalmic complications in inflammatory bowel disease (IBD) reported that ocular disorders are the third most common manifestation of the disease, and advised physicians to perform ophthalmic evaluations,1 according to the lead study author is Wiktoria Pytrus, MD, from Ophthalmonology Clinical Centre SPEKTRUM, Wroclaw, Poland.

The investigators explained that while the clinical manifestations of IBD, which include Crohn’s disease and ulcerative colitis, are primarily in the gastrointestinal tract, about 25% of patients are affected by extraintestinal complications and these include eye diseases. Musculoskeletal and mucocutaneous involvement are seen most often after the gastrointestinal tract and ocular diseases follow.

Their primary findings include the following. “Episcleritis, frequently occurring in IBD patients, may be associated with exacerbation of the intestinal disease. Uveitis does not correlate with IBD activity but may be related to the presence of other extraintestinal manifestations, particularly erythema nodosum and peripheral arthritis. Early detection and specific therapy of ocular manifestations of IBD are fundamental to avoiding sight-threatening complications,” Dr Pytrus and colleagues reported.

Specifically, they found that ocular symptoms are seen in from 0.3% to 13% of all patients with IBD, in patients with ulcerative colitis from 1.6% to 5.4% and in Crohn’s disease from 3.5% to 6.8%. Episcleritis occurs in 2% to 5% and anterior uveitis in 0.5% to 3.5% of patients with IBD.

Regarding treatment, systemic corticosteroids or immunosuppressants may be necessary in patients with severe disease to control the ocular inflammation. Persistent and relapsing conditions usually respond well to tumor necrosis factor-α-inhibitors.

The researchers emphasized the importance of collaboration between gastroenterologists and ophthalmologists to ensure that patients are treated appropriately.

They concluded, “Ocular involvement in IBD is a rare extraintestinal manifestation, but it may be critical because of its potential sight-threatening complications if not treated promptly and accurately.”

Reference
  1. Pytrus W. Akutko K, Pytrus T, Turno-Krecicka A. A review of ophthalmic complications in inflammatory bowel diseases. J Clin Med. 2022;11:7457. https:// doi.org/10.3390/jcm11247457

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