Did you know that inflammatory bowel disease (IBD) isn’t only a digestive condition? It can also attack your vision. Your host, Amber J Tresca, breaks down some of the most common eye-related extra-intestinal manifestations (EIMs) of Crohn’s disease and ulcerative colitis. Learn how to identify the warning signs of episcleritis, uveitis, and scleritis, and find out when you need to see an ophthalmologist right away to protect your eyesight.

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Key Chapters & Timestamps

• 00:00 – Introduction: Protecting your vision with IBD
• 02:07 – What are Extra-Intestinal Manifestations (EIMs)?
• 04:21 – How common is eye disease in IBD patients?
• 05:43 – Condition 1: Episcleritis (Symptoms and treatments)
• 07:15 – Why episcleritis often tracks with IBD flares
• 10:14 – Condition 2: Uveitis (Red flags and risks of vision loss)
• 13:58 – Condition 3: Scleritis (Rare but severe complications)
• 16:51 – Condition 4: Dry Eyes
• 18:23 – Risk Factors: Who is most likely to develop IBD eye issues?
• 20:10 – When to call your doctor and why you need an ophthalmologist
• 23:25 – Practical tips: Keeping eye drops in the fridge

Sources:

• Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2015;21(8):1982-1992. doi:10.1097/MIB.0000000000000392
• Mintz R, Feller ER, Bahr RL, Shah SA. Ocular manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2004;10(2):135-139. doi:10.1097/00054725-200403000-00012
• Crohn’s & Colitis Foundation. Eye complications in IBD. https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/eyes.pdf
• Rosenbaum JT, Bodaghi B, Couto C, et al. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum. 2019;49(3):438-445. doi:10.1016/j.semarthrit.2019.06.004
• World Health Organization. Vitamin A deficiency and ocular health. https://www.who.int/data/nutrition/nlis/info/vitamin-a-deficiency
• Rufo PA, Denson LA, Sylvester FA, et al. Health supervision in the management of children and adolescents with IBD: NASPGHAN recommendations. J Pediatr Gastroenterol Nutr. 2012;55(1):93-108. doi:10.1097/MPG.0b013e31825959b8

Find Amber J Tresca at:

• AboutIBD.com: About IBD
• Verywell: Verywell Health
• Facebook: @aboutIBD
• Twitter: @aboutIBD
• Pinterest: @aboutibd
• Instagram: @about_IBD
• YouTube: @AboutIBD
• Threads: @about_IBD

Find Mac Cooney (mix, sound design, and theme music) at:

• Facebook: @maccooneycomposer
• Instagram: @maccooneycomposer
• Web: Cooney Studio
• YouTube: @MacCooneyComposer
• Theme music, IBD Dance Party, is from ©Cooney Studio.

These show notes may contain affiliate links. If you choose to purchase after clicking a link, Mal and Tal Enterprises, LLC may receive a commission at no extra cost to you.

Transcript

[Music: IBD Dance Party]

Amber J Tresca 00:00:04 I’m Amber and this is About IBD. I was diagnosed with ulcerative colitis as a teen and had surgery ten years later. Now I help people with Crohn’s disease and ulcerative colitis understand their disease and feel seen. On About IBD. You’ll get real talk on symptoms, treatment, and life with IBD straight from patients, caregivers, and experts. You’ll learn, feel less alone, and even have a laugh along the way. I have a question for you. When you think about inflammatory bowel disease and I’m talking about Crohn’s disease and ulcerative colitis, which body part comes to mind? Of course you think of your digestive system, but did you think about your eyes at all? Probably not. Unless you’ve already had an eye disorder connected to your IBD. But it’s a fact that having IBD puts you at risk for having eye disorders. I’m sorry if I’m the first one to tell you this. It is completely unfair. We already deal with so much and this just seems like adding insult to injury. Today we’re going to talk about how and why eye diseases are connected to IBD.

Amber J Tresca 00:01:18 Which signs to watch, for, which symptoms are urgent and which can wait and why? Eye problems are something you need to call your doctor about sooner rather than later. Protecting your vision is so important, and when you have IBD, you need to be proactive about it. I know that I’m a huge fan of being able to see, and I’m willing to bet that you are to. One of the most frustrating and misunderstood things about IBD is that it is not only a digestive disease. Crohn’s disease, ulcerative colitis, and indeterminate colitis are immune mediated inflammatory conditions. What this means is that the immune system has lost its mind and becomes dysregulated. It attacks the digestive system, as we already know, but it doesn’t stop there. It also affects other body systems, I mean rude. The problems that affect us outside the digestive system are called extra intestinal manifestations. If you read a medical paper or go to a medical conference, you might hear it abbreviated as IEM. An aim can crop up at any point in the disease journey.

Amber J Tresca 00:02:29 Some people struggle more with the EIMs than they do with the IBD. Sometimes people have an aim before they’re even diagnosed with an IBD, and in other cases, aims get worse when the IBD flares up, but others will not follow the course of the IBD. Some aims include arthritis, liver disease, skin disorders and eye diseases. Eye disease is one of the more common EIMs, and it might affect anywhere from 4% to 12% of people with IBD, but every study reports a different range, so it could be as high as 29%. The point is, eye disease in IBD is not rare, so it is something that you should know about. So first question why would I be the effect our eyes. We often take our eyesight for granted, and there doesn’t seem to be a through line between our gut and our eyes, so eye disease might go unnoticed at first, unless you know that it can be connected to your IBD. The inflammation caused by IBD affects our immune system. The inflammatory pathways cause ulcerations in the digestive system and can also lead to inflammation in other parts of the body.

Amber J Tresca 00:03:46 Another factor in all of this is the anatomy of the eye. The eye contains a complex vascular system that has a rich blood supply. The vascular structures of the eye can become inflamed. Eye diseases can flare up at the same time the IBD does, or they can appear when. IBD is in remission. Yeah, I know it’s not cute. Okay, now we’ve established that eye disease is possible. Let’s get more specific and talk about the common forms of eye diseases that are connected to IBD. There are three main inflammatory conditions associated with IBD, and they’re called episcopal rites uveitis and sclerites. There is also the possibility for another milder but still very annoying condition that is your basic dry eye. Don’t worry, we’re going to go through them one by one because this is way too many. Tituss. Up first, let’s talk about episcopal rights. There’s a thin layer just above the white of the eye that’s called the Apus. Clara. When it gets inflamed, it’s called epi sclerites. The symptoms of EPAs chlorides include redness, irritation, and some tenderness in the eye.

Amber J Tresca 00:04:59 The eye might feel like there’s something in it, like a grain of sand, but it’s impossible to flush it out. If you have IBD and you experience any of these symptoms, you should see your eye doctor or your primary care physician. Epistolary is one of these aims that might track with the IBD, so it might occur during a flare up. It’s often treated with lubricating drops and sometimes anti-inflammatory eyedrops. But here’s the good news about epistolary. Epistolary. This is annoying and nobody wants it. But it is not a condition that could lead to vision loss. Eyedrops are used to manage the condition, but ultimately, getting the IBD back under control is the most important part of the treatment. Of course, that’s easy to say. It’s not easy to do. No matter what the wellness influencers tell you. Oh wait, did I say that out loud? Moving on. Let’s talk about the second eye condition that’s associated with IBD. And that is uveitis. The middle layer of the eye is called the uvea.

Amber J Tresca 00:06:03 When the uvea becomes inflamed, it causes uveitis. This condition is more serious. The symptoms of uveitis can include eye pain, redness, blurred vision, sensitivity to light, and that is also called photophobia and floaters. And that is when there’s shapes that drift through your vision and they look like specks, dots, lines or cobwebs. Besides the fact that uveitis is serious, the second most important thing to understand about this condition is that it does not always track with IBD flares. You can be in remission from IBD and still develop uveitis. This is important to keep in mind because we can’t always connect our random health conditions with IBD. And if you’re in remission or you’re in deep remission, you might not think that an eye that’s red and painful could be serious or could be related to your IBD. And if you or your health care providers are not connecting the dots. And that’s not to say that you’re ignoring your health, because I know that you don’t. And not to say that any of your physicians don’t know what’s going on, because I know that they do.

Amber J Tresca 00:07:07 But you may not think of IBD and connect it to uveitis at the outset of these symptoms. Untreated uveitis, unfortunately, is associated with complications such as glaucoma, cataracts, or even permanent vision loss. That is why it is urgent to get it diagnosed and treated. If you are experiencing eye pain and light sensitivity, that’s your sign to get seen by your eye doctor or if you need a referral to one, get seen by your primary care physician or your gastroenterologist. This is not a situation where you can wait and see what happens in a few days. Call your provider and insist on an urgent ophthalmology visit. The treatment for uveitis is steroids. They can be given in a variety of ways, and that includes eyedrops, injections in or around the eye, oral steroids, or with prescription implants that are placed inside the eye. Eye drops that dilate the eye might also be prescribed for the pain. I know this is all scary and unappealing, and it sounds like something from a horror movie. Does that mean I’m the creepy local lady who warns everybody about the danger only to be ignored? Yeah, well that tracks.

Amber J Tresca 00:08:28 The last item is sclerites. The white wall of the eye is called the sclera. When the sclera becomes inflamed, it causes sclerites. This is rare, but it’s still important to know about because it can lead to vision loss. If untreated, the pain from sclerites can be significant, and it almost feels like something is boring into the eye. Even moving your eyes can be painful, and it might also cause red eyes and changes to your vision. If you have symptoms of sclerites, it’s important to get it looked at and treated right away. Some of the treatments might include eyedrops, steroids, and or artificial tears, or oral steroids, oral nonsteroidal anti-inflammatory drugs, and antibiotics if there is also an infection. Sometimes sclerites doesn’t respond to any of the treatments I described. That can mean that surgery or anti-inflammatory drugs might be needed, and some of those drugs are also used to treat IBD. So just like uveitis, sclerites is serious, it needs treatment. And it does not always track with IBD flares.

Amber J Tresca 00:09:33 So you can be in remission and still develop sclerites. I know I keep bringing the bad news like the creepy local lady in a horror movie, but she always turns out to be right, doesn’t she? Okay, moving on, let’s talk about dry eyes. This is a lot less dramatic, but as someone who has experienced it myself, it can still be painful, annoying, and it really balks up your life. People with IBD are more likely to experience dry, irritated eyes. This could be due to inflammation associated with the IBD, or it could also happen as a side effect of a medication or even a nutritional deficiency. This is one of the many reasons why all your health care providers need to know that you live with an IBD, including your eye doctor. Eye drops are the most common treatment for dry eye, but it’s important to ask the doctor about this because not everything you see on the shelf in the pharmacy will be helpful. In fact, some eye drops could make the problem worse.

Amber J Tresca 00:10:36 In some cases, prescription eyedrops might be used for dry eye. It does seem like it’s a small problem, but I was prescribed eyedrops by my eye doctor for dry eye because nothing else was helping, and it was surprisingly painful and affecting my eyesight. And those eye drops were expensive. I kept them in the refrigerator, though, and putting in a few drops in the morning and at night felt so good that I was willing to do just about anything to afford them. But check for coupons and shop around for the best prices, because you can almost always get these drops for a little lower price, even with insurance. The good news is that I did not need the prescription eyedrops to treat dry eye forever. Eventually, I could just use artificial tears from the drugstore and that worked just fine. But even those can be expensive, so look for sales or discounts. And at this point, I’m going to fully embrace being the creepy horror movie lady and recommend that you keep a vial of artificial tears in your IBD emergency Kit at all times.

Amber J Tresca 00:11:37 Because we never know what this stupid disease is going to do to us. All right, let’s move on to some risk factors. You already know by now that having a form of IBD puts you at higher risk for developing an eye disease or disorder. However, there are a few things that might raise that risk even more. The first is having an active IBD flare up. Eye disease can happen in remission, but having a flare puts us at risk for a lot of complications. The second is that people with Crohn’s disease might be slightly more likely to have certain eye problems, but again, it can happen with any form of an IBD. Third, having other extra intestinal manifestations, and especially having joint pain or arthritis puts us at a higher risk. Again, they all don’t seem connected, but it’s that inflammation that is at the heart of it all. Fourth, smoking is a risk factor, so it’s important for everyone with an IBD to stop smoking. And lastly, being female and being older are also risk factors for eye disease.

Amber J Tresca 00:12:53 Now let me give you some practical tips on what to look for when it comes to IBD in your eyes. Here are some symptoms that should prompt you to call your eye doctor or your gastroenterologist. Persistent redness in one or both eyes. Eye pain, especially deep eye pain. Light sensitivity. Blurred or decreased division. New floaters or severe dryness that doesn’t improve with at home treatment. And when I say redness, it could mean a little bit of redness, but it could also be really pronounced and impossible to ignore. And how do you know when an eye condition is urgent? When there’s pain, redness and light sensitivity? Those are major clues that something serious is brewing and your eyes need to be checked right away. And notice that I’ve said a few times now that you should call your doctor. Folks, this is not a patient portal message. This is a reason for an actual phone call, so you can be evaluated urgently. If you can’t get one of your regular health care providers to look at you right away.

Amber J Tresca 00:13:48 Head to urgent care or go to a walk in eye care center. Don’t wait for someone to take it seriously. Get it looked at right away. I know I don’t like making phone calls either, but when I woke up in, my eyelids were sticking to my eyeballs. I called my eye doctor and I got in right away. Okay, let’s sum it all up. When it comes to IBD and eye disorders, eye problems with IBD are considered uncommon, but they are not rare. There are several eye conditions associated with IBD, but here are the ones that we really need to know about which is uncomfortable. Usually has mild symptoms and might get better or worse at the same time as the IBD. Uveitis can be serious and affect eyesight. It can occur in a flare or during remission and sclerites, which is quite painful and is always a problem that needs to be addressed urgently. Symptoms such as eye pain, light sensitivity, blurred vision or redness are reasons to call your health care provider. Hopefully you already have a relationship with an eye doctor.

Amber J Tresca 00:14:54 If not, consider establishing care and seeing your eye doctor annually. I get it. It’s frustrating because at the very least, you already see your gastro at least once a year, plus all the other specialists like a dermatologist, a dentist, and a gynecologist. And then there’s more if you live with arthritis or other extra intestinal manifestations. It gets expensive not only to pay for these appointments, but also because of all the time lost going to them. But we have to take care of our eyes too, and we should try not to skip those yearly or every other year appointments with an eye care health professional. If you learned something and this episode was helpful, please share it with someone touched by IBD who might want to know more about how these stupid diseases are affecting our eyes. Take care of your gut. Stay on your treatment plan and watch your eyes for any changes, and I’ll see you next time. Hey, a super listener. Check the show notes to find links and information about the topics discussed in this episode.

Amber J Tresca 00:15:57 Plus, get a written transcript and much more on my website about IBD. If you enjoyed this episode, please consider sharing it with someone else or leaving a rating in your podcast app. Reviews and ratings help me grow this show and bring you more great content. Thanks for listening and remember. Until next time, I want you to know more about IBD.

Amber J Tresca 00:16:39 What the [bleep] is happening right now?