Eyes: Uveitis/Episcleritis

Eye inflammation is a well recognized extraintestinal manifestation in Crohn’s disease and ulcerative colitis. The most common problems are episcleritis and uveitis, which can cause eye redness, pain, and light sensitivity. Some forms are mild, but others threaten vision and need urgent specialist care. This article explains key symptoms, urgency signs, and how these eye problems connect with IBD.

Key Takeaways

• Ocular manifestations affect roughly 2–10% of people with IBD, most often episcleritis or uveitis. (ncbi.nlm.nih.gov)

• Episcleritis usually causes a red, irritated eye without vision loss and often parallels IBD gut activity. (ncbi.nlm.nih.gov)

• Uveitis is less common but more dangerous, with pain, light sensitivity, and blurred vision, and can cause permanent vision loss if untreated. (academic.oup.com)

• Any red eye with moderate to severe pain, marked light sensitivity, or vision changes needs same‑day urgent eye evaluation. (jamanetwork.com)

• Eye inflammation in IBD is best managed jointly by an ophthalmologist and the gastroenterology team, sometimes with shared immunosuppressive treatment. (academic.oup.com)

How IBD Affects the Eyes

Inflammatory bowel disease can involve organs outside the gut, known as extraintestinal manifestations. The eyes are among the most commonly affected sites after joints and skin. (ncbi.nlm.nih.gov)

Ocular manifestations occur in about 2–5% of people with IBD, although some series report higher rates. (ncbi.nlm.nih.gov)
The main IBD‑related inflammatory eye conditions are:

• Episcleritis

• Scleritis (a deeper, more severe form)

• Uveitis

These problems can appear during active intestinal disease or, particularly for uveitis, when the gut seems quiet or even before IBD is diagnosed. (ncbi.nlm.nih.gov)

Because untreated inflammation can lead to scarring and vision loss, eye symptoms in someone with IBD deserve prompt attention.

Episcleritis: Often Mild, Still Important

Episcleritis is inflammation of the thin, vascular layer (episclera) that lies on top of the white of the eye. (ncbi.nlm.nih.gov)

Typical features:

• Bright or patchy redness of the white of the eye

• Mild discomfort, burning, or irritation

• Watery eye

• Vision is usually normal, and light sensitivity is minimal or absent (journals.lww.com)

Episcleritis is the most common ocular manifestation in IBD and is seen more often in Crohn’s disease than ulcerative colitis. (academic.oup.com)
Its activity often parallels gut inflammation, so flares may occur when bowel symptoms worsen. (ncbi.nlm.nih.gov)

Most cases are:

• Self‑limited over 1–3 weeks

• Managed with lubricating drops, cold compresses, and sometimes topical nonsteroidal or steroid drops

• Improved by better control of the underlying IBD (ncbi.nlm.nih.gov)

When Episcleritis May Not Be “Just” Episcleritis

Features that suggest something more serious, such as scleritis or uveitis, include:

• Moderate or severe, deep eye pain

• Pain that worsens with eye movement

• Marked light sensitivity

• Blurred or dim vision

• A sense of pressure in the eye

The presence of these symptoms makes simple episcleritis less likely and should trigger urgent eye evaluation. (journals.lww.com)

Uveitis: An Eye Emergency

Uveitis is inflammation of the uvea, the middle layer of the eye that includes the iris (colored ring), ciliary body, and choroid. (jamanetwork.com)

In IBD:

• Uveitis occurs in roughly 0.5–3% of patients

• It is often more common in women and those with ulcerative colitis

• It may be linked with joint and skin manifestations

• It often does not track directly with bowel activity and can precede IBD diagnosis (academic.oup.com)

Typical symptoms of anterior uveitis (iritis) include:

• Eye pain, often deep and aching

• Redness that is most intense around the cornea (ciliary flush)

• Marked sensitivity to light

• Blurred vision or new floaters

• Headache on the same side as the affected eye (academic.oup.com)

Uveitis can affect one or both eyes. Even when symptoms are not dramatic, ongoing inflammation can quietly damage the eye and cause:

• Cataracts

• Glaucoma

• Macular edema (swelling of the central retina)

• Retinal detachment

• Permanent vision loss (jamanetwork.com)

Why Urgent Evaluation Matters

Guidelines for IBD‑associated uveitis recommend urgent, same‑day ophthalmology assessment when uveitis is suspected. (academic.oup.com)

An ophthalmologist performs a slit‑lamp examination to confirm uveitis, rule out infection, and classify the type (anterior, intermediate, posterior, or panuveitis). Treatment may include:

• Steroid eye drops for anterior uveitis

• Oral or injected steroids for more extensive disease

• Cycloplegic drops to relieve pain and prevent complications

• Steroid‑sparing agents such as methotrexate or mycophenolate

• Anti‑TNF biologics such as infliximab or adalimumab for severe or refractory cases (academic.oup.com)

Because systemic immunosuppressants are often used for both IBD and uveitis, coordinated care between gastroenterology, ophthalmology, and sometimes rheumatology is important.

Scleritis: Severe Pain, High Risk

Scleritis is inflammation of the sclera, the tough white coat of the eye. It is less common than episcleritis but more dangerous. (ncbi.nlm.nih.gov)

Typical features:

• Intense, boring eye pain, often radiating to the face or head

• Pain that worsens with eye movement or at night

• Deep red or violaceous discoloration of the eye

• Possible blurred vision or vision loss

Recurrent scleritis can lead to thinning of the sclera, retinal detachment, and optic nerve problems, so aggressive systemic treatment and rapid specialist input are needed. (ncbi.nlm.nih.gov)

Red‑Flag Eye Symptoms in Someone With IBD

Emergency and specialty guidelines highlight several eye symptoms that warrant urgent or emergency evaluation, particularly in a person with IBD: (academic.oup.com)

• Sudden or noticeable loss of vision, dimming, or a new blind spot

• Moderate to severe eye pain, especially if deep, throbbing, or worse with movement

• Marked sensitivity to light

• Red eye with blurred vision or halos around lights

• New floaters, flashes of light, or a shadow or “curtain” in the visual field

• Severe headache with eye pain, nausea, or vomiting

• Persistent red eye for more than a day or two in someone with IBD, especially with any pain or vision change

• Red, painful eye after eye trauma, recent eye surgery, or in a contact‑lens wearer

Most cases of itchy, sticky red eye in the general population are simple conjunctivitis, but in IBD, the threshold for urgent evaluation is lower because episcleritis, uveitis, and scleritis are more likely than in people without systemic inflammation. (aafp.org)

How Eye Inflammation Relates to IBD Treatment

The relationship between eye disease and gut disease varies:

• Episcleritis often flares and settles in parallel with intestinal activity, and improved IBD control usually helps. (ncbi.nlm.nih.gov)

• Uveitis and scleritis may appear even when bowel symptoms are quiet and sometimes precede IBD diagnosis. They often require their own treatment plan. (academic.oup.com)

Several systemic therapies used for IBD, especially anti‑TNF biologics, thiopurines, methotrexate, and other immunomodulators, may also control refractory uveitis or scleritis. (academic.oup.com)

Eye specialists generally screen for infections and other causes before starting or escalating immunosuppressive therapy, since infectious uveitis requires targeted antimicrobial treatment rather than steroids alone. (academic.oup.com)

FAQs

Can eye inflammation occur when IBD seems completely quiet?

Yes. Uveitis and scleritis can appear independently of gut activity and sometimes occur before any bowel diagnosis is made. Episcleritis is more likely to parallel intestinal flares. (ncbi.nlm.nih.gov)

Are red, itchy eyes in someone with IBD always related to IBD?

No. Conjunctivitis, dry eye, or allergies remain the most common causes of red, itchy eyes in the general population. However, in a person with IBD, a red eye combined with pain, light sensitivity, or vision change raises concern for episcleritis, uveitis, or scleritis and warrants prompt assessment. (aafp.org)

Does controlling IBD always fix the eye problems?

Improved bowel control often helps episcleritis, which typically tracks with intestinal activity. Uveitis and scleritis may need separate, targeted treatment and can persist despite good gut control, although systemic IBD therapies sometimes benefit both conditions. (ncbi.nlm.nih.gov)

Which specialists should be involved when IBD‑related eye disease is suspected?

Current guidelines support close collaboration between a gastroenterologist and an ophthalmologist experienced in uveitis, with rheumatology involvement when there is broader joint or autoimmune disease. This team approach helps balance gut control, eye inflammation, and the safety of systemic immunosuppression. (academic.oup.com)