Eyes: Uveitis/Episcleritis

Inflammatory bowel disease can affect the eyes. The two most common problems are episcleritis and uveitis. Most red eyes are mild, but some eye symptoms can threaten vision if not treated quickly. Knowing the warning signs and acting fast protects sight. Eye issues can flare with gut activity or, in the case of uveitis, occur even when the bowel is quiet. (academic.oup.com)

Key takeaways

• Eye pain, light sensitivity, or sudden vision changes need same‑day eye care. Go to urgent care or an emergency department if an ophthalmology visit is not available. (mayoclinic.org)

• Episcleritis causes redness and mild discomfort. It is usually not dangerous and often improves as gut inflammation is controlled. (academic.oup.com)

• Uveitis can threaten vision. It often causes pain, light sensitivity, and blurred vision. It requires urgent evaluation and treatment. (mayoclinic.org)

• Severe deep eye pain suggests scleritis, not episcleritis. Scleritis needs urgent specialist care. (ncbi.nlm.nih.gov)

• Some IBD medicines affect the eyes. S1P modulators can cause macular edema, and steroid eye drops must be used only under eye specialist guidance. (drugs.com)

What are episcleritis and uveitis

• Episcleritis is inflammation of the thin layer on top of the white of the eye. It causes redness and a gritty or tender feeling. Vision is usually normal. Flares often track with active IBD. (academic.oup.com)

• Uveitis is inflammation inside the eye. Anterior uveitis, also called iritis, is most common in IBD. It can cause pain, light sensitivity, blurry vision, and floaters. Uveitis may appear when the gut is calm or even before IBD is diagnosed. (mayoclinic.org)

Red flags: When to seek urgent care

Seek same‑day ophthalmology care, or go to urgent care or an emergency department, for any of the following:

• Moderate to severe eye pain or pain that wakes a person from sleep

• Light sensitivity, halos around lights, or sudden blurred or decreased vision

• Red eye with headache, nausea, or vomiting

• New floaters or a curtain over vision

• Contact lens wear with painful red eye

• Eye trauma or chemical exposure

• Eye symptoms in someone who is immunosuppressed
  These are signs of conditions like uveitis, scleritis, keratitis, or acute glaucoma. Rapid assessment protects sight. (mayoclinic.org)

How doctors tell them apart

• Episcleritis: redness, mild discomfort, surface vessels that may blanch with phenylephrine drops, and normal vision. Often self‑limited. (ncbi.nlm.nih.gov)

• Scleritis: deep aching pain that can radiate to the face, worse at night, red‑purple hue, and possible vision changes. Does not blanch with phenylephrine. Needs urgent care. (ncbi.nlm.nih.gov)

• Uveitis: eye pain, photophobia, blurred vision, ciliary flush around the cornea, and inflammatory cells seen on slit‑lamp exam. Urgent care is required. (mayoclinic.org)

Quick comparison

Evidence summaries and guideline statements support these patterns. (academic.oup.com)

Treatment overview

Treatment is tailored by an eye specialist after excluding infection.

• Episcleritis

• Lubricating drops and cool compresses.

• Manage the IBD flare. Short courses of topical or oral anti‑inflammatory medicine may be used when symptoms are bothersome. (academic.oup.com)

• Uveitis

• First‑line for anterior uveitis is topical corticosteroid drops with pupil‑dilating drops. Intermediate, posterior, or panuveitis may need periocular, intravitreal, or systemic steroids.

• If inflammation is sight‑threatening or keeps recurring, steroid‑sparing therapy is considered. Anti‑TNF agents such as adalimumab or infliximab are recommended when disease persists, ideally in a joint plan between gastroenterology and ophthalmology. Adalimumab is FDA‑approved for noninfectious uveitis. (academic.oup.com)

• Scleritis

• Often needs systemic therapy, for example oral NSAIDs or oral steroids. Severe or necrotizing cases may need immunomodulators or biologics. Close ophthalmology care is essential. (academic.oup.com)

Important cautions:

• Never start or reuse steroid eye drops without an eye exam. Steroids can worsen unrecognized infections, including herpes, and can raise eye pressure or speed cataract formation. (pmc.ncbi.nlm.nih.gov)

• Herpes zoster or herpes simplex involving the eye needs antiviral therapy. Steroids, if used, must be supervised by an eye specialist. (ncbi.nlm.nih.gov)

Medicines used for IBD and eye safety

• Systemic corticosteroids can raise eye pressure and increase cataract risk with repeated or long use. Eye monitoring is advised if prolonged courses are needed. (academic.oup.com)

• Sphingosine‑1‑phosphate (S1P) modulators, such as ozanimod and etrasimod, can cause macular edema. Labeling recommends a baseline fundus exam including the macula, periodic checks while on therapy, and immediate evaluation for any vision changes. Risk is higher with diabetes or a history of uveitis. (drugs.com)

What to do right now if eye symptoms start

• Stop contact lens use.

• Do not use leftover steroid eye drops.

• Use preservative‑free artificial tears if eyes are irritated.

• Seek same‑day ophthalmology care for pain, light sensitivity, or vision changes. If this is not available, go to urgent care or an emergency department. (mayoclinic.org)

Follow‑up and prevention

• Report any new eye symptoms early, even if bowel symptoms are quiet.

• Keep IBD under control, since episcleritis and scleritis often track with gut activity.

• If uveitis was diagnosed in the past, arrange fast access to eye care for flares.

• If starting an S1P modulator, confirm an eye exam plan with the care team. (academic.oup.com)

FAQs

Can eye inflammation happen before IBD is diagnosed

Yes. Uveitis can precede an IBD diagnosis or occur independent of bowel activity. (pubmed.ncbi.nlm.nih.gov)

Which IBD medicines help prevent uveitis flares

For recurrent or severe uveitis, anti‑TNF therapy is often effective. Adalimumab has an FDA indication for noninfectious uveitis, and infliximab has supportive evidence. Choice depends on the full clinical picture. (academic.oup.com)

When is a red eye an emergency

A red eye with pain, light sensitivity, or any vision change needs urgent evaluation. Severe headaches, vomiting, halos around lights, or trauma also require emergency care. (mayoclinic.org)