Crohn’s Disease and Ocular Manifestation
Crohn’s disease or simply known as CD is a type of chronic relapsing IBD which is an inflammatory bowel disease (Charlton et al., 2017). There is a transmural granulomatous inflammation that characterizes this disease and has a tendency to affect colon or ilium, which are the gastrointestinal tract. In the last 50 years, the prevalence of Crohn’s disease has been increasing. There have been some reports from the patients about a significant impediment to daily activities and lifestyle during both the remissions and flares regardless of a biological treatment that is used on the patient.
It has been observed that almost 10 % of the total population suffering from the inflammatory bowel disease Crohn’s, experience problems related to the eyes (Rollandi et al., 2016). Even though most of the patients do not have a major threat such as loss of vision, it still is yet another complication to control and the last area you would expect affected by CD. The tissues that make up the eye are very similar to the tissues in the digestive system. Thus, the organs that are affected by the Crohn’s disease can and do affect the eye as well. These manifestations include uveitis, episcleritis, dry eyes, scleritis and keratoconjunctivitis.
Uveitis is considered one of the most severe complications in inflammatory bowel disease or Crohn’s. Uveitis is painful inflammation of the eye's middle layer also known as the uvea. A patient suffering from uveitis has pain, redness of the eye, light sensitivity, and blurred vision. The symptoms of uveitis occur slowly or develop over time depending upon the intensity of the disease on the patient.
Episcleritis is simply the inflammation of the episclera, which is the outer coating of the white of the eye. After the inflammation of the episclera is tiny blood vessels, the vessels start to dilate and the area around becomes red. Moreover, tenderness and pain is produced by the episcleritis.
When the vitamin A is deficient in the human body, it may lead to dryness of the eyes. The condition of eyes to become dry is KCS or keratoconjunctivitis sicca. An irritation or eye infection can result due to this condition, which is caused by increased tear film evaporation or the decreased tear production. There is always a chance for the inflection to become severe and which can lead to use the antibiotics regularly.
The inflammation of the sclera, which is the white of the eye, referred to as Scleritis. Episcleritis and scleritis appear to be similar by their names and appearance, but one cannot deny the fact that the scleritis is more serious than the episcleritis (Rollandi et al., 2016). There is a high probability that the scleritis will lead to visual impairment if not treated on time. The patient, who suffers from inflammatory bowel disease, also has a greater chance to suffer from scleritis as well (Charlton et al., 2017). However, the condition of scleritis is still a rare one. The condition can affect one or both eyes of the patient. The patient suffering from scleritis suffers from eye discoloration, eye tenderness, tears, pain, decreased visual sharpness, and redness of the eye.
There is a high chance for the development of inflammation in optic nerve and retina as well. However, CD is not always responsible for the problems related to eyes, as there is a high probability of the medications used in the treatment of the disease that can result in the creation of some new problems (Quigley et al., 2016). For example, taking corticosteroids in an excess amount or taking for a long-term can result in cataracts and glaucoma. Glaucoma is clouding of eye’s lens, which is responsible for impairing visions.
For Crohn’s disease, there is no cure, but the disease still has some treatment goals that helps in reducing the inflammations, relieving symptoms of bleeding, diarrhea, and pain, and eliminating the nutritional deficiencies (Quigley et al., 2016). However, for the eyes, there are a number of drugs to involve in the treatment along with surgery, supplements, and a combination of the therapies. Uveitis after identifying the type, which is done by using a slit lamp that helps the doctor and allows him to look at the inside of the patient’s eye. Moreover, the improvement in the Uveitis comes after taking IBD under control, but still, there are some eye drops recommended by the ophthalmologists that contain steroids that reduce inflammation. If the effects of uveitis are on the front of the eye, then steroid eye drops are utilized in the treatment. The tablets and steroid injections are also used for the treatment in other areas of the eye. Some people are not cured just with the steroid medication. These people are given different medications as well, which may include eye drops or immunosuppressant in order to relieve the pain. There are some cases of uveitis in which the disease clears quickly, just after the treatment is started.
To treat the keratopathy a slit lamp is used by the ophthalmologist in making the diagnosis with the help of spotting white deposits that are presented at the cornea's edge. The results of Keratopathy are not severe, as it does not cause vision loss. This issue does not need treatment, as it can be resolved on its own (Galanopoulos et al., 2016). However, if there is a need of treatment for keratopathy, then the focus is to control the IBD of the person.
Some topical vasoconstrictors and steroid eye drops are used in the treatment of episcleritis. The inflammation in the IBD of a person is reflected by the episcleritis. The drug is therapy one of the main treatment used for the patients suffering from episcleritis (Quigley et al., 2016). It helps in bringing IBD under control and can serve as the sole treatment of episcleritis. Cool compress and tears can be used for the treatment of mild cases. In some severe cases, there is a requirement to use NSAIDs, which are Non-steroidal anti-inflammatory drugs.
The dry eyes are because of the deficiency of Vitamin A and can be corrected by taking the Vitamin A supplements either an intramuscular injection or orally. Some drugs can be helpful in treating the Crohn’s disease, as well with the eyes.
A slit lamp, which is a special microscope, used to diagnose the scleritis. The medical history of the patient matters a lot as it helps to determine what the causes behind the scleritis are. The treatments to cure the scleritis are quite same as of CD such as steroid medication, biological drugs, or even immunomodulatory drugs. Some topical eye drops help to get better from this situation. The anti-inflammatory drops or simply known as NSAIDs along with steroid drops are also used in the treatment of scleritis. The treatment sometimes includes the injections near the eyes, and sometimes there is a need to perform surgery in order to repair the damage to the sclera.
If the treatment given to the instruction is as per the instructions and requirements, then there is a comparatively less chance for any side effect on the health of the patients. In the case of uveitis, there are a number of drugs to involve in the treatment along with surgery, supplements, and a combination of the therapies (Galanopoulos et al., 2016). Some people not cured just with the steroid medication, they must be given different medications. It may include eye drops or immunosuppressant in order to relieve the pain. However, after the treatment in some cases, there is a chance to develop a disease, known as glaucoma. Moreover, it can create a problem with the retina, and damage to the optic nerve as well. The patients even face the loss of their vision in some cases.
The patients who face the episcleritis and repeatedly rake steroid treatment has a great chance to experience some side effects, which may include steroid-induced glaucoma, ocular hypertension, and cataract formation. Episcleritis can be uncomfortable and can have rare complications.
Many complications can occur due to the treatment and can result in an outcome of scleritis. The condition can further result in inflammation of retinal swelling, cataract, glaucoma, uveitis, cornea, retinal macular swelling, and peripheral corneal shinning. Occasionally, the proper medication not taken on time or dosage exceeded; it can lead to the thinning of the sclera. The outcomes of the thinning of sclera can lead to blindness or severe vision loss as well. The long-term use of steroid eye drops in the treatment can result in glaucoma or cataract.
Researchers are trying their best to find new ways for the treatment of Crohn’s disease which in turn will decrease the occurrence of eye manifestations. The latest ongoing treatments use medications to block inflammation at the source and in turn could as well help eye issues associated with Crohn’s disease. The anti-inflammatory drugs that used for the treatment of Crohn’s treatment are limited to short-term use but have severe effects on the entire body of the patient. Researchers suggest the use of new corticosteroids like beclomethasone dipropionate and budesonide even though take a longer time to work, they are more effective and contain very few side effects.
The mercaptopurine and azathioprine are in the current use for the treatment of Crohn’s disease and are common immune system suppressors. However, research has found that these immune system suppressors can cause some serious side effects that may include the risk of infection as well. For the future treatments, add those regular blood tests to the immune system suppressor drugs for the monitoring of the potential side effects of liver, kidney, and blood system.
The utilization of vedolizumab will contain a less risk for the brain disease, and it works like natalizumab, which has the high risk of brain disease. In the future, base the treatment for Crohn’s disease on the vedolizumab, which will work more specifically on the intestinal tract. The ustekinumab or simply known as Stelara will be used in the future as it has the capability to treat the Crohn's disease at the time when the other medications do not work.
Literature Review
Crohn’s disease is an inflammatory disease localized in the bowel of the human body. It can have a far-reaching effect on the ileum, colon, gastrointestinal, eyes and the perineum organs of the human body. According to Dr. Prakash Galani, Crohn’s disease is a threat that can hamper the quality of life as it compromises the facts. The etiology of the disease is not completely understood because of the complexities associated with the treatments and the impacts that the treatment can have on the patient. It is asserted that the cause of the can be traced in various fields such as microbiological, genetic, immunological and the environmental factors. About 10% of the patients are suffering from ocular manifestations. Many of the researches have revealed that the disease is a multi-system disorder that has the potential to effect such as keratoconjunctivitis, Iritis and retinal inflations and it is more common in men as compared to women. It refers to reduces tear production, loss of vision and infection.
There is an evident diversity in the treatment with the passage of time; many of the biological therapies introduced along with a remarkable usage of immunomodulatory drugs. Certain steps for the awareness of the disease are being taken, offering benefits to both the field and the associations. Many of the studies have asserted that there are certain drawbacks associated with the treatment as well, such a drawback are so potent that they are influencing the rate of the treatment opted to cure the disease.
With the advancement of the technology, variation in the fields of treatment and other facilitating instruments and strategies have undergone empowerment. However, certain efforts are under process to eradicate the harmful impacts associated with the disease. The research article asserts the mitigation of the drawbacks, intimating the complications and the use of strategies to facilitate the patients at a significant and healthy priority.
Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 200 patients. Medicine (Baltimore) 2006; 55:401-12.
Work Cited
Charlton, Rachel, et al. "Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis: a population-based cohort study." Annals of the rheumatic diseases (2017): annrheumdis-2017.
Galanopoulos, M., et al. "A successful treatment of anterior nodular scleritis with topical corticosteroids in a patient with Crohn’s Colitis." J Inflam Bowel Dis & Disord 1.1 (2016).
Ijsr.net. N. p., 2018. Web. 12 Sept. 2018.
Koev, Kr. "Crohn’s Disease Ocular Manifestations." Acta Medica Bulgarica 41.2 (2014): 61-66.
Quigley, Eamonn MM. "Overlapping irritable bowel syndrome and inflammatory bowel disease: less to this than meets the eye?" Therapeutic advances in gastroenterology 9.2 (2016): 199-212.
Rollandi, Gian Andrea, Riccardo Piccazzo, and Francesco Paparo. "Extraintestinal Findings in Crohn’s Disease Patients." Crohn’s Disease. Springer, Cham, 2016. 127-136.
