Eye Problems in Crohn’s Disease: What to Watch For and When to Seek Care

Crohn’s disease can involve the eyes in a noticeable minority of people, and some eye issues can be serious if not treated promptly. The most common eye manifestations include conjunctivitis, episcleritis, scleritis, and uveitis; less commonly, the retina, optic nerve, or eye pressure can be affected. ^[1] Eye symptoms do not always track with bowel flares, and occasionally eye problems may even come before gut symptoms. ^[1]

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How Common Are Eye Issues?

• Ocular involvement occurs in roughly 4–12% of people with inflammatory bowel disease (IBD), with episcleritis reported more often in Crohn’s disease. ^[2]
• Extraintestinal manifestations overall affect more than 25% of people with IBD, and ocular complications occur in around 10%. ^[1]
• Inflammation in the eye and inflammation in the gut are rarely tightly correlated, so eye problems can arise even when bowel symptoms seem controlled. ^[1]

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Key Eye Conditions Linked to Crohn’s

Conjunctivitis and Episcleritis

• Episcleritis (inflammation of the thin outer layer on the white of the eye) is relatively common in Crohn’s and can cause redness and tenderness; it is usually less painful and less dangerous than deeper inflammation. ^{[2] [1]}

Scleritis

• Scleritis is a deeper, more painful inflammation of the white of the eye and can threaten vision if untreated. ^[1]
• Management often requires systemic anti-inflammatory or immunosuppressive therapy, and azathioprine has shown benefit particularly for scleritis in IBD. ^[3]

Uveitis (Iritis/Anterior Uveitis)

• Uveitis is one of the more serious ocular complications and is the most frequent severe eye manifestation reported in IBD, more often anterior and nongranulomatous. ^[1]
• Symptoms typically include eye pain, light sensitivity (photophobia), redness, and blurred vision. ^[1]
• Uveitis can occur independently of bowel disease activity and may be more refractory when HLA‑B27 positive. ^{[1] [3]}

Posterior Eye Involvement (Less Common but Important)

• Posterior uveitis, intraretinal hemorrhages, vasculitis, choroiditis, optic neuropathy, and vaso‑occlusive events have been reported, and these can affect central vision or visual fields. ^[1]
• Retinal vascular occlusive disease (vein or artery occlusion) has been described in Crohn’s, sometimes preceding the Crohn’s diagnosis. ^[4]
• Optic neuritis/optic neuropathy can occur as a sole manifestation of IBD in rare cases. ^[5]

Treatment-Related Eye Effects

• Steroids used for IBD can increase the risk of cataracts or glaucoma (higher eye pressure), especially with prolonged exposure. ^[1]
• Dry eye (keratoconjunctivitis sicca) has been associated with certain 5‑aminosalicylic acid therapies. ^[1]

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Symptoms That Should Prompt Medical Evaluation

Urgent or Emergency Symptoms

• Sudden change in vision, partial or complete vision loss, or new double vision warrants immediate medical care. ^[6]
• Red eye accompanied by severe eye pain, headache, fever, nausea/vomiting, or light sensitivity should be treated urgently. ^[6]

Concerning Symptoms (Seek Prompt Evaluation)

• Eye pain, marked light sensitivity (photophobia), blurred vision, or pronounced eye redness may indicate uveitis or scleritis and should be assessed soon by an eye specialist. ^[1]
• Persistent tenderness on the white of the eye, especially with deeper aching pain, can suggest scleritis. ^[1]
• New floaters, flashes of light, or a curtain over part of your vision can signal posterior involvement and needs prompt care. ^[1]
• Eye redness or pain is recognized among extraintestinal symptoms of Crohn’s and should not be ignored. ^{[7] [8]}

Routine Symptom Awareness

• Milder redness with discomfort may reflect episcleritis, but evaluation helps distinguish it from more serious scleritis. ^[1]
• Dry, irritated eyes can occur with some IBD medications and deserve discussion with your clinician. ^[1]

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How Eye Problems Are Managed

• Initial management often uses topical steroids, non‑steroidal anti‑inflammatory agents, and cycloplegic drops to reduce inflammation and pain, tailored to the specific diagnosis. ^[2]
• More severe or refractory cases may need systemic steroids or immunosuppressive drugs (such as azathioprine, methotrexate, mycophenolate, cyclosporine) to control inflammation and protect vision. ^{[2] [9] [10]}
• Biologic therapies (for example, infliximab or adalimumab) can be effective when conventional therapy does not adequately control IBD‑related ocular inflammation. ^{[2] [10]}
• Early diagnosis and timely treatment reduce the risk of lasting complications; in some cases, surgery may be required for complications like cataracts. ^[2]

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Why Early Care Matters

• Uveitis is a leading cause of vision loss worldwide, and when associated with systemic diseases like IBD, coordinated care between gastroenterology and ophthalmology can improve outcomes. ^[10]
• With appropriate medical and surgical strategies, vision can often be maintained or improved even in complex cases. ^[3]

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Practical Tips for People with Crohn’s

• Report any new eye symptoms promptly even if your gut symptoms are quiet because eye and bowel inflammation often do not run in parallel. ^[1]
• Ask your clinicians about potential eye side effects when starting or continuing steroids and other IBD medications, and consider periodic eye exams if you require long-term therapy. ^[1]
• If you experience red, painful eyes with light sensitivity or blurred vision, prioritize an ophthalmology evaluation to rule out uveitis or scleritis. ^{[1] [6]}

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Quick Reference: Common Eye Issues and Actions

Eye issue	Typical symptoms	How urgent?	Usual approach
Episcleritis	Redness, tenderness, mild discomfort	Prompt but not emergent	Topical therapy; evaluate to exclude scleritis [2] [1]
Scleritis	Deep eye pain, redness, possible vision changes	Urgent	Systemic anti‑inflammatories or immunosuppressants; specialist care [1] [3]
Anterior uveitis (iritis)	Pain, light sensitivity, blurred vision, redness	Urgent	Topical steroids, cycloplegics; may need systemic therapy [1] [2]
Posterior uveitis/retinal vasculitis	Floaters, blurred or lost vision, visual field defects	Urgent	Systemic steroids/immunosuppressants; consider biologics [1] [10]
Steroid‑related cataract/glaucoma	Glare, progressive blur; or high eye pressure	Prompt	Medication review; surgery or pressure‑lowering treatment as needed [1] [2]
Dry eye (therapy‑related)	Grittiness, burning, fluctuating vision	Routine	Lubrication; adjust medications if needed [1]

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When in Doubt, Get Checked

• Seeing a healthcare professional urgently is advised for any sudden vision change or red eye with significant pain or light sensitivity. ^[6]
• Because Crohn’s can lead to eye problems in both adults and children, referral to an ophthalmologist for an examination is appropriate when eye symptoms appear. ^{[11] [12]}

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