Purchase this article with an account.
Maite Sainz de la Maza, Nicolas Molina, Luis A. Gonzalez-Gonzalez, Priyanka P. Doctor, Joseph Tauber, Stephen Foster; Scleritis Associated with Inflammatory Bowel Disease. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6249.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the demographic characteristics, clinical features, ocular complications, and successful therapeutic regimens in patients with scleritis associated with inflammatory bowel disease (IBD).
Retrospective case series. We reviewed the electronic health records of 500 patients with scleritis seen at two tertiary referral centers and selected the ones with IBD. Patient characteristics, clinical features, ocular complications and successful therapeutic regimens were evaluated.
Of 500 patients with scleritis, 11 patients had IBD (2.2%), 9 with Crohn's disease (CD) and 2 with ulcerative colitis (UC); that includes 8 women and 3 men with a mean age of 47 years (range, 33 to 67 years). Six of the patients with CD had diffuse scleritis, 1 had nodular scleritis, 1 had necrotizing scleritis, and 1 had necrotizing scleritis and posterior scleritis; anterior uveitis was present in 2 patients, peripheral keratitis in 3 patients, and glaucoma in 1 patient but final visual acuity was not decreased in any patient. Scleritis occurred after several episodes of anterior uveitis in 2 patients. The 2 patients with UC had diffuse scleritis with anterior uveitis without corneal lesions or glaucoma or decrease of vision. There was no previous uveitis. Scleritis was the initial manifestation whose study led to the diagnosis of CD in 4 of the 9 patients and to the diagnosis of UC in all 2 patients. All 11 patients had arthritis and had recurrent scleritis. Successful therapeutic regimens in scleritis with CD included 1 patient with sulfasalazine, 1 patient with intravenous steroids, 3 patients with methotrexate, 2 patients with azathioprine, and 2 patients with infliximab. Successful therapeutic regimens in scleritis with UC included 1 patient with infliximab and 1 patient with sirolimus.
Scleritis associated with IBD is more common in CD than in UC. It is usually recurrent and may take the form of any type of scleritis, including necrotizing and posterior scleritis. Although ocular complications may appear, they unfrequently cause decrease of vision. Patients who develop scleritis after recurrent anterior uveitis should be examined for CD. Scleritis associated with IBD is more common in patients with arthritis and may be the initial manifestation of CD or UC. Scleritis associated with IBD most often will require immunomodulatory therapy or biologic response modifier drugs.
This PDF is available to Subscribers Only