Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). The underlying inflammation of UC can lead to eye conditions such as scleritis and uveitis. Without treatment, some conditions may lead to vision loss.
UC is a chronic condition that primarily affects the large intestine. It is a type of IBD, meaning that inflammation is generally the cause of most of its symptoms. These include urgent bowel movements, bloody stool, and abdominal pain.
Many of the typical symptoms of UC directly involve the gastrointestinal tract, but they can also affect other parts of the body, such as the joints, bones, muscles, skin, or even the eyes.
This article discusses which eye conditions can link to UC, possible treatments, and when it might be time to talk with a doctor.
Some eye conditions might directly result from UC, while others could be more indirect secondary effects.
Although the exact cause of UC is not known, it is currently understood to be an immune-mediated disease. This means that the immune system mistakenly attacks healthy tissue in the gut, causing inflammation that leads to symptoms of UC. Sometimes, this same immune response can cause inflammation in other areas, potentially leading to the eye conditions listed below.
Scleritis
Scleritis, as with UC, is an inflammatory condition. It affects the sclera, which people commonly refer to as the whites of the eyes.
Scleritis causes pain and inflammation that worsens with eye movement, particularly at night. There are two main types: anterior scleritis, which affects the front of the eye, and posterior uveitis, which affects the back of the eye.
If left untreated, scleritis may lead to
Treatment for scleritis might include:
- steroid eye drops
- corticosteroid pills
- nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen
- oral antibiotic or antiviral medication
- immunosuppressive and immunomodulatory drugs (used for severe conditions to prevent or alter the immune system response)
In severe cases, surgery might be the best option to repair the eye and prevent further vision loss.
Episcleritis
Episcleritis is an inflammatory condition that affects the episclera, a thin layer of tissue that wraps around the sclera. Between
Symptoms of episcleritis are generally mild, such as eye redness or discomfort. It will often resolve on its own within
- a
topical corticosteroid such as fluorometholone or loteprednol etabonate - corticosteroids
- NSAIDs
- anti-inflammatory eye drops
Uveitis
Uveitis is another type of inflammation in the eyes. It affects the uvea, or the middle layer of the eye, which consists of several layers.
Common symptoms include red eyes, pain, blurriness, and light sensitivity. Uveitis is typically treatable but can cause vision loss if not properly addressed.
Treatment typically involves steroids to reduce inflammation. These may consist of eye drops, pills, or injections. If the symptoms do not respond to treatment, surgery might be an option. This is where a surgeon places a small implant in the eye, which releases small amounts of a steroid over time.
Optic neuritis
The optic nerve sits at the back of the eye and converts incoming light into electrical signals for the brain to interpret. Optic neuritis occurs when the optic nerve becomes inflamed. This inflammation can damage the myelin sheath, the protective coating around the optic nerve, which may lead to vision loss or impairment.
Symptoms of optic neuritis often include:
- blurred vision
- dim vision
- colors appearing dull and washed out
- pain at the back of the eye socket
- pain with eye movement
Treatment is not always necessary. It often depends on the type of optic neuritis a person has and how it has affected them. If treatment is needed, options may include:
- over-the-counter pain medication
- intravenous or oral steroids
- immunosuppressants
Retinal conditions
A variety of conditions can affect the retina, the layer of cells lining the back wall inside the eye. The retina converts light into electrical signals that are sent to the brain so people can see. People over age 55 with IBD may have an increased risk of retinal conditions compared with people who do not have IBD.
One such retinal condition is
PEDs may not always cause any obvious symptoms or can lead to blurry vision. The treatment options will depend on the exact location and nature of the tear but may include:
Dry eye syndrome
Dry eye syndrome, more often known as dry eyes, is an extremely common condition with a wide range of possible symptoms and levels of severity.
For people with UC, dry eyes could be a secondary effect stemming from other eye conditions such as uveitis. Treatment options may include:
- artificial tears
- anti-inflammatory eye drops, such as cyclosporine or lifitegrast
- tear duct plugs
A person’s doctor might also suggest
- avoiding smoke, wind, and air conditioning
- using a humidifier at home
- reducing screen time or taking frequent breaks from screens
- using wraparound sunglasses outdoors
- staying hydrated
- maintaining a good sleep schedule
Surgery is not often required for dry eye but might be necessary if the lower eyelids are too loose, as this can cause tears to drain too quickly out of the eye. If surgery is necessary, a doctor will repair the eyelids to help keep the tears in the eye.
Conjunctivitis
The conjunctiva is the membrane that covers the inside of the eyelids. The term for inflammation in this area is conjunctivitis, more commonly known as pink eye.
There are many possible causes of conjunctivitis. While there is no demonstrated causal link between conjunctivitis and UC, it can sometimes be a secondary effect due to the other possible eye conditions connected to UC.
Most cases are mild and will eventually clear on its own. Some cases of viral conjunctivitis can take
Bacterial conjunctivitis is often treated with antibiotics, especially if there is any pus or certain types of bacteria. If the person with pink eye is immunocompromised, they may also receive antibiotic treatment.
For allergic conjunctivitis, a doctor might suggest allergy medication, eye drops, or a combination of drugs.
UC can cause a variety of eye conditions, either directly or indirectly. Some will have more obvious and immediate symptoms, while other conditions, such as
An ophthalmologist can diagnose symptomatic eye conditions when they occur and may be able to detect asymptomatic eye conditions during routine checkups. If a person has UC, it may be useful to share this information with their ophthalmologist to receive more specialized care.
Treatment will depend on the person’s eye condition. In some cases, home treatments such as NSAIDs, cold compresses, and eye drops may be adequate. In the most severe cases, surgery may be necessary to repair damage and avoid vision loss.
If a person has an eye condition due to UC, their doctor can help devise a treatment plan that fits their needs.
Many treatment options for UC include medication to reduce inflammation. Inflammation is frequently associated with the eye conditions covered above, so these medications could also potentially help to prevent inflammation in and around the eyes. The types of medications include:
- aminosalicylates
- corticosteroids
- immunosuppressants
- biologics
- Janus kinase (JAK) inhibitors
This is still an active area of research.
For eye conditions related to UC, reducing inflammation can help ease a person’s symptoms and potentially help prevent vision loss.
Some medications used to treat UC may be associated with eye complications. Long-term use of corticosteroids, for example, may cause:
- cataracts, cloudy areas in the lens of the eye that can impair vision
- glaucoma, a group of eye conditions that damage the optic nerve
People with UC should talk with their doctors about possible eye health risks associated with their medication.
There are many eye conditions a person might experience if they have UC. Some conditions are mild, but others can lead to permanent vision loss or eye damage.
If the person is experiencing pain, irritation, excessive redness, or visual impairment such as blurriness, it might be best to have a doctor check their eyes. Symptoms will not necessarily line up with UC flare-ups.
Even if a person is not experiencing any symptoms, it is still important to visit an eye doctor for an annual checkup.
The exact cause of UC is unknown, but inflammation plays an important role. That same inflammatory response can also lead to several eye conditions with varying degrees of severity.
People with UC may want to ask their doctors for more information about the eye conditions that can affect them and how to manage their symptoms.