Richardson Holly, Yoon Giho, Moussa George, Kumar Aditi, Harvey Philip
Department of Undergraduate Medical Education, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK.
Manchester Royal Eye Hospital, Manchester M13 9WL, UK.
Biomedicines. 2024 Dec 16;12(12):2856. doi: 10.3390/biomedicines12122856.
Inflammatory bowel disease (IBD) is a complex, multisystemic disease and is associated with ocular pathology in 4-12% of patients. In general, ocular disease affects Crohn's patients more frequently than those with ulcerative colitis. Episcleritis and uveitis are the most common presentations, with episcleritis often correlating with IBD flares, whereas uveitis presents independently of IBD activity and, in some cases, may even alert clinicians to a new diagnosis of IBD. Corneal EIMs encompass a range of pathologies, such as the common and benign keratoconjunctivitis sicca (dry eye disease), which nevertheless causes significant patient discomfort, and the rarer condition of peripheral ulcerative keratitis, which warrants urgent review due to the risk of corneal perforation. Alongside EIMs, clinicians should also be aware of the iatrogenic consequences to the eye following treatment of IBD. Corticosteroids may cause cataracts, glaucoma, and-indirectly via hyperglycaemia-diabetic retinopathy. Methotrexate is irritating to ocular tissues and may cause conjunctivitis and blepharitis. Biologic medications, such as anti-TNFα agents, overlap in their use as treatment of both IBD and uveitis, and yet in some patients may also increase the risk of acute uveitis flares, as well as opportunistic, sight-threatening infections. With integrated care between gastroenterology and ophthalmology, patient outcomes can be improved by facilitating earlier detection and management of ocular disease. This narrative review summarises the ocular extraintestinal manifestations of IBD, including pathophysiology, epidemiology, and current treatment strategies.
炎症性肠病（IBD）是一种复杂的多系统疾病，4%至12%的患者伴有眼部病变。一般来说，眼部疾病在克罗恩病患者中比溃疡性结肠炎患者更常见。表层巩膜炎和葡萄膜炎是最常见的表现，表层巩膜炎常与IBD发作相关，而葡萄膜炎的出现与IBD活动无关，在某些情况下，甚至可能提醒临床医生对IBD作出新的诊断。角膜眼肠病包括一系列病变，如常见的良性干燥性角结膜炎（干眼症），尽管如此，它仍会给患者带来极大不适，以及较罕见的周边溃疡性角膜炎，由于存在角膜穿孔风险，需要紧急评估。除了眼肠病，临床医生还应了解IBD治疗对眼睛造成的医源性后果。皮质类固醇可能导致白内障、青光眼，并通过高血糖间接引发糖尿病性视网膜病变。甲氨蝶呤对眼部组织有刺激性，可能导致结膜炎和睑缘炎。生物药物，如抗TNFα药物，在治疗IBD和葡萄膜炎时会重叠使用，但在某些患者中，也可能增加急性葡萄膜炎发作以及机会性、威胁视力感染的风险。通过胃肠病学和眼科的综合护理，可通过促进眼部疾病的早期发现和管理来改善患者预后。这篇叙述性综述总结了IBD的眼部肠外表现，包括病理生理学、流行病学和当前的治疗策略。
