How to manage eye disorders with crohn’s disease

As many as 12 percent of people with Crohn’s disease experience eye complications. Here’s what you need to know to protect your vision.

How to manage eye disorders with crohn's disease

With all the steps you take to control the gastrointestinal effects of Crohn’s disease, your eyes may be the last area you’d expect to be affected. Yet as many as 12 percent of people with Crohn’s disease experience eye complications, according to a research review published in March 2016 in the Journal of Crohn’s and Colitis.

“The tissues that [make up] the eye are very similar to tissues in other parts of the body, so inflammatory diseases that affect other organs, such as the bowel in Crohn’s disease, will affect the eye as well,” explains Calvin Roberts, MD, a clinical professor of ophthalmology at Weill Cornell Medicine and the chief medical officer at Bausch and Lomb.

The connection between Crohn’s and your eyes also comes down to the way your immune system behaves. “With Crohn’s, the body attacks the eye similarly to the way it attacks the tissue in the gastrointestinal tract,” says Paul J. Dougherty, MD, the medical director of Dougherty Laser Vision in Los Angeles and a clinical instructor of ophthalmology at UCLA’s Jules Stein Eye Institute.

Because the eyes are so sensitive — think of how much irritation a tiny eyelash can cause if it gets into your eye — eye problems in Crohn’s may show up before the gastrointestinal symptoms of inflammation set in. So if you have repeated episodes of eye inflammation, get screened for Crohn’s disease, suggests Dr. Roberts.

Complicating the situation further, some Crohn’s disease treatments can contribute to eye conditions as well. “Oral steroids are frequently used in the treatment of Crohn’s, and steroids can cause both glaucoma, high pressure in the eye, and cataract, which is a cloudy lens,” says Dr. Dougherty.

Different Eye Complications in Crohn’s Disease

Here’s what you need to know about specific eye problems associated with Crohn’s.

Uveitis One of the most common eye problems in Crohn’s, according to the Crohn’s & Colitis Foundation, uveitis is inflammation of the uvea — “a blood-vessel-rich lining inside the eye that brings nutrition to the cornea, retina, iris, and lens,” Roberts says. “When inflamed, the uvea becomes swollen, the retina swells, and vision becomes blurred.” The blurry vision associated with uveitis may strike suddenly or come on gradually, he says.

An ophthalmologist can diagnose uveitis with a slit lamp, which is a microscope that examines the inside of your eye. This painless exam is important because if left untreated, uveitis can lead to glaucoma — an eye disease that causes pressure within the eyeball and can potentially lead to vision loss, explains Dougherty.

Episcleritis Another common eye complication in Crohn’s disease is episcleritis, or inflammation of the outer coating of the white area of your eye, according to the Crohn’s & Colitis Foundation. “When people have active Crohn’s disease, episcleritis also seems to flare — there is a clear relationship,” Dougherty notes. Symptoms of episcleritis include generalized or local redness of the eyes and mild soreness or discomfort, according to Johns Hopkins Medicine.

Dry eyes Dry eye syndrome, also called keratoconjunctivitis sicca (KCS), is an eye complication associated with Crohn’s that’s caused by reduced tear production or increased tear film evaporation, according to the Crohn’s & Colitis Foundation. Dry eyes can lead to itching, burning, or infection. Dougherty says that a few mechanisms can lead to this eye complication in Crohn’s, including the same inflammation that irritates the GI tract. But also, “with Crohn’s disease, many people get malabsorption of nutrients, including vitamin A, and without enough vitamin A, you can get dry eye syndrome or, in severe cases, night blindness,” he says.

Keratopathy Another eye condition associated with Crohn’s disease is keratopathy, an abnormality of the cornea in which white deposits form, according to the Crohn’s & Colitis Foundation. It may result from uveitis or dry eyes. An ophthalmologist can diagnose keratopathy with a slit lamp exam.

Uveitis and episcleritis are usually treated with steroid eye drops, used frequently during the day, Roberts says. “Most patients respond to eye drops, but those who do not may require corticosteroids taken by mouth or other anti-inflammatory medications,” he adds.

Treatments for dry eye syndrome may include artificial tears or eye drops containing cyclosporine, a drug to reduce inflammation caused by dryness.

If keratopathy is advanced or bothersome enough to require taking action, it may be treated with eye drops containing a calcium binding agent and a procedure that involves scraping the surface of the cornea, according to Columbia University’s Department of Ophthalmology.

Lowering Your Risk for Crohn’s Eye Problems

Because the inflammatory process in the eye is similar to the process in the bowel, episodes of eye inflammation tend to coincide with Crohn’s GI flare-ups, says Roberts. “So the same advice given to deter bowel relapses applies to eye flares. Avoid tobacco and caffeine, and decrease stress to the bowel by eating smaller, more balanced meals,” he suggests.

Roberts also stresses the importance of routine eye examinations, both to look for eye problems in Crohn’s and for your general wellness. “A comprehensive eye examination will not only detect problems in your eye like uveitis, it can also be an important indicator of overall health,” he says. “Changes that may be slowly evolving in the body often present themselves within the eye’s fragile structure first, and can be found during a routine eye exam.”

Eye checkups should be more frequent when you have Crohn’s, says Dougherty. “A person with Crohn’s disease who is taking steroids should have an eye exam every 6 to 12 months,” he recommends.

To protect your vision, see your eye care professional as soon as any unusual eye symptoms arise, and also discuss how often you’ll need different types of eye screening. “Risk factors that can elevate your need for an eye health exam include a family history of eye disease — especially macular degeneration or glaucoma — obesity, smoking, and diabetes,” Roberts notes.

Additional reporting by Quinn Phillips.

Those living with the bowel disease are at risk of eye complications. Here’s how to stay healthy.

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

Even if you don’t suffer from the cramps, abdominal pain, and diarrhea that typically come with Crohn’s disease, you probably know that Crohn’s is a chronic inflammatory bowel disease—as in, it affects the gastrointestinal tract.

How to manage eye disorders with crohn's disease

But because Crohn’s is a form of immune dysfunction, it’s also considered a systemic disease—one that can affect other parts of the body, too, explains Sashidhar Sagi, MD, a gastroenterologist at Indiana University Health. Symptoms that show up outside of your GI tract are called extraintestinal manifestations (EIMs), and research shows that they occur in 25 to 40 percent of people with inflammatory bowel disorders.

EIMs can impact your skin, joints, liver, and your eyes. In fact, as many as 12 percent of people with Crohn’s disease experience minor to serious eye complications, according to a research paper published in the Journal of Crohn’s and Colitis.

Wait, how can Crohn’s impact my eyes?

“Crohn’s is an autoimmune disease, and autoimmune diseases occur when the body’s immune system has been sensitized to attack normal body tissues,” explains Nathan Hamburger, MD, an ophthalmologist and member of the medical staff at at UCHealth Yampa Valley Medical Center. “There’s enough similarity between the tissue in the digestive system and some tissues found in the eye that the immune system will attack both.”

According to Sagi, there are three eye conditions associated with Crohn’s disease:

  • Episcleritis: This develops when the tissue between the clear and outermost layer of the eye becomes inflamed. Symptoms include redness, mild pain, and sensitivity to touch.
  • Uveitis: This develops when the tissue underneath the white layer of your eye becomes inflamed, resulting in redness, light sensitivity, pain, and blurred vision. If left untreated, uveitis can lead to glaucoma and vision loss.
  • Dry eye syndrome (aka keratoconjunctivitis sicca): This occurs when tear glands become inflamed and cause white deposits to form in the cornea. Symptoms may include itching, burning, or infection. Keratopathy, a type of corneal disease, may also develop.

So, how can I keep my eyes healthy?

While these conditions are rare, the best way to prevent Crohn’s-related eye problems is to work with your gastroenterologist to ensure your getting the proper treatment, Hamburger says.

Yearly eye exams are also vital, as they can help ensure you’re not developing undiagnosed problems, Hamburger says. Early detection can be a game-changer in terms of both successful treatment and preserving healthy vision.

What should I do if my eyes start bugging out?

If you’re having a Crohn’s flare and notice any problems with your eyes (such as blurred vision, pain, redness, or dryness), see a doctor immediately, Sagi says. In many cases, getting the symptoms under control can be enough to resolve eye issues. Depending on the problem, your doc may also prescribe steroid eye drops, topical vasoconstrictors, or even vitamin A supplements.

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How to manage eye disorders with crohn's disease

Although Crohn’s Disease is known for causing digestive problems, it can also affect other areas of your body. Individuals with Crohn’s may experience skin complications, joint pain, and eye problems. About 10 percent of individuals with Crohn’s have problems with their eyes at some point.

The exact cause of eye problems is not clear. However, we know that eye tissue is susceptible to inflammatory problems caused by inflammatory bowel disease. Crohn’s Disease symptoms that appear outside the gastrointestinal tract are known as extra-intestinal manifestations, and occur in 25-40 percent of individuals with inflammatory bowel disease. The risk of developing eye problems increases when you have at least one other extra-intestinal manifestation of Crohn’s. Alternatively, eye problems may be side effects of Crohn’s Disease medications. Discuss new symptoms such as vision issues with your doctor.

Eye Problems Linked to Crohn’s Disease

Episcleritis

Episcleritis is inflammation in the episclera, the tissue between the clear outermost layer of the eye and the white part of the eye, the sclera. This condition causes inflammation in the eye’s tiny blood vessels, which causes redness in the sclera. Other symptoms include tenderness, watery eyes, and pain. Episcleritis does not cause blurred vision or light sensitivity as other conditions do. While this eye problem is the most common Crohn’s Disease eye issue, it is less painful than other associated eye problems. Episcleritis is often present before, or at the time, Crohn’s disease is initially diagnosed.

Scleritis

Scleritis is inflammation of the sclera (the white part of the eye). This condition causes watery eyes, redness, pain in and around the eye, burning, blurred vision, headaches, difficulty sleeping, and sensitivity to light. The sclera gives the eye its shape, and in severe scleritis cases, the sclera can begin to thin over time.

Uveitis

Uveitis is inflammation in the uvea, the eye layer just below the sclera that includes the iris, the colored part of the eye. Uveitis symptoms include redness, pain, blurred vision, and sensitivity to light. Symptom onset may be rapid or may slowly develop over time. This condition is less common than episcleritis, but more serious. Uveitis may lead to glaucoma or vision loss if not treated. This condition is four times more common in women than men, and associated with other extra-intestinal manifestations including arthritis and problems with the sacroiliac joint.

Keratopathy

Keratopathy causes blister-like swelling in the cornea, the clear outer part of the eye. It appears as tiny white deposits at the edge of the cornea, which can be seen by your ophthalmologist. Symptoms include irritation, excess tearing, discharge, sensitivity to light, and feeling as if something is stuck in the eye.

Dry Eyes

Dry eyes, formally known as keratoconjunctivitis sicca, are caused by decreased tear production. Symptoms include redness, stinging, itching, burning, pain, and feeling as if something is stuck in the eye. Dry eyes may alternatively be caused by vitamin A deficiency. If so, your doctor may recommend taking a vitamin A supplement to correct the deficiency and alleviate the symptoms.

Optic Neuritis

Optic neuritis is rarely seen with Crohn’s Disease but is a possible complication. The optic nerve communicates with the brain and translates the light and color your eyes take in into the objects your brain sees and recognizes. When your optic nerve is inflamed or irritated you may experience poor vision, blurry vision, trouble seeing out of one eye, pain when moving your eye, and seeing colors less vividly. If left untreated, optic neuritis may lead to permanent eye damage.

Treating Eye Problems

Seeing your doctor for a visual examination is the first step in treating eye problems associated with Crohn’s Disease. Your doctor will use a variety of tools including special lights, microscopes, and drops to identify which part of your eye is affected.

Different conditions require different treatments.

  • Episcleritis is treated with cold compresses or topical steroids to relieve inflammation.
  • Scleritis is treated with eye drops or oral medications.
  • Uveitis is treated with topical or systemic steroids to clear inflammation, or medications to dilate the pupil.
  • Keratopathy is treated with lubricating fluid or gel. If the condition does not resolve, prescription eye drops are used.
  • Dry eyes are treated with eye drops or warm compresses.
  • Optic neuritis may resolve on its own, but if it does not, IV medications, injections, and steroids are all treatment options.

In general, treating Crohn’s disease and reducing inflammation will also alleviate eye problems. Additionally, avoiding Crohn’s flares also reduces the risk of developing eye problems in the future. To lower your flare risk and subsequent eye problems avoid excess alcohol, caffeine, smoking, and non-steroidal anti-inflammatories, and manage your stress level. Consistent follow-ups with your doctor to manage your Crohn’s disease and an eye specialist to identify any eye problems early is best for your overall health.

Working with a dietitian or nutritionist to maintain remission and avoid flares is another great way to optimize your overall health.

  • Symptoms
    • What Are Symptoms of Crohn’s Disease?
  • Eye Problems
    • What Eye Problems Are Related to Crohn’s?
  • Diagnosis
    • How Are Eye Problems Caused by Crohn’s Disease Diagnosed?
  • Treatment
    • What Is the Treatment for Eye Problems Due to Crohn’s Disease?
  • Guide
    • Why Does Crohn’s Affect Eyes? Topic Guide

How to manage eye disorders with crohn's disease

Crohn’s disease is a type of inflammatory bowel disease (IBD) that involves chronic inflammation of the gastrointestinal tract. Crohn’s disease can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. It is different from ulcerative colitis, another type of IBD, that only affects the colon (large intestine).

It’s not entirely clear why Crohn’s disease affects the eyes in some people. Crohn’s is an inflammatory disease, and inflammatory conditions often affect multiple parts of the body. The medications used to treat Crohn’s disease can also contribute to eye problems. For example, long-term corticosteroid use can lead to glaucoma or cataracts.

What Are Symptoms of Crohn’s Disease?

Symptoms of Crohn’s disease can develop slowly and progressively worsen:

  • Frequent bowel movements
  • Diarrhea
  • Abdominal pain and cramping
  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue
  • Fever
  • Weight loss
  • Gastrointestinal ulcers
  • Rectal bleeding/blood in stool
  • Disease around the anus
  • Shortness of breath due to anemia
  • Skin lesions and joint pain and swelling (most commonly seen in Crohn’s granulomatous colitis)
  • Inflammatory abscesses of fistulas (in severe cases)

What Eye Problems Are Related to Crohn’s?

About 10% of people with an inflammatory bowel disease such as Crohn’s experience eye problems such as:

  • Uveitis
    • Inflammation of the uvea (middle layer of the eye wall)
    • Symptoms include pain, blurred vision, sensitivity to light, and eye redness
  • Keratopathy
    • An abnormality of the cornea
  • Episcleritis
    • Inflammation of the outer coating of the white of the eye (the episcleral)
    • Symptoms include eye redness, pain, and tenderness
  • Dry eyes
    • Caused by decreased tear production or increased tear film evaporation
    • Symptoms include eye infection and irritation such as itching and burning

How Are Eye Problems Caused by Crohn’s Disease Diagnosed?

In patients who have Crohn’s disease, eye problems are diagnosed with an eye exam and use of a “slit lamp” that allows the doctor to look at the inside of the eye.

What Is the Treatment for Eye Problems Due to Crohn’s Disease?

Treatment for Crohn’s disease involves a combination of medications, diet changes, and sometimes surgery. When Crohn’s disease is controlled, eye problems usually improve.

Medications used to treat Crohn’s disease include:

  • Aminosalicylates (5-ASA)
  • Azathioprine
  • Corticosteroids
  • Antibiotics
  • Sulfasalazine

Diet changes used to treat Crohn’s disease include:

  • Eating a healthy, balanced diet that includes:
    • Refined grains
    • Low-fiber fruits
    • Vegetables that are fully cooked, skinless, seedless, and non-cruciferous
    • Lean proteins
    • Oral nutritional supplements
    • Homemade protein shakes
    • Water, broth, tomato juice, and rehydration solutions to stay hydrated
  • Eating 4-6 small meals daily
  • Restricting dairy intake in patients who are lactose-intolerant
  • During flares:
  • Consuming soft, bland foods
  • Avoiding spicy or high-fiber foods

Surgery used to treat Crohn’s disease includes:

  • Strictureplasty: to repair a narrowing (stricture)
  • Bowel resection: to remove a damaged portion of the small or large intestine
  • Fistula removal
  • Abscess drainage
  • Colectomy: removal of the colon
  • Proctocolectomy: removal of the colon and rectum

Specific treatment for eye problems caused by Crohn’s disease include:

  • Uveitis: eye drops containing steroids to help reduce inflammation
  • Keratopathy: usually it does not require treatment
  • Episcleritis: steroid eye drops and topical vasoconstrictors
  • Dry eyes: artificial tears, Vitamin Asupplements (orally or by intramuscular injection), and antibiotics for severe infection

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

Priyanka Chugh, MD, is a board-certified gastroenterologist in practice with Trinity Health of New England in Waterbury, Connecticut.

Inflammatory bowel disease (IBD) not only affects the digestive tract but is also associated with conditions in several other parts of the body. The eyes seem like an unlikely place to be affected, but in fact, there are several eye conditions that are more prevalent in people who have IBD. Uveitis is an uncommon eye condition associated with IBD. If untreated, it can lead to loss of vision.

How to manage eye disorders with crohn's disease

People with IBD not only need regular care from a gastroenterologist, but regular care from an eye doctor is also needed. Uveitis and other eye conditions associated with IBD aren’t common but it is important that they get diagnosed and treated right away if they do develop. People with IBD who have sudden eye pain or other symptoms in the eye should see an eye doctor right away and then call their gastroenterologist.

Uveitis is an inflammation in the middle layer of the eye—the uvea. The uvea contains the iris (the colored part of the eye), ciliary body (tissue that surrounds the eye lens), and choroid (the blood vessels and tissue between the white of the eye and the retina). Uveitis can be a chronic condition. Types of uveitis include:

  • Anterior: Inflammation is located in the iris
  • Diffuse: Inflammation throughout the uvea
  • Intermediate: Inflammation is in the ciliary body
  • Posterior: Inflammation of the choroid

Symptoms

When associated with IBD, the onset of uveitis may be insidious, and uveitis could even be present before the IBD is diagnosed. Symptoms of uveitis are different depending on the type:  

  • Anterior: Sensitivity to light, pain, red-eye, and some loss of vision
  • Diffuse: Sensitivity to light, pain, red eye, some loss of vision, blurred vision, and floaters
  • Intermediate: Often painless, blurred vision, floaters  
  • Posterior: Often painless, blurred vision, floaters  

Causes

Uveitis is associated with several inflammatory diseases including rheumatoid arthritis, sarcoidosis, lupus, and IBD. Uveitis can also be caused by a bacteria or fungi; injury to the eye; or exposure to certain toxic chemicals. In some cases, no clear cause can be found for the development of uveitis. There may also be a genetic component to uveitis, as a particular gene called HLA-B27 has been found to be associated with as many as half of the cases of uveitis in people who also have IBD.

Prevalence

Somewhere between .5 and 9 percent of people who have IBD will also develop uveitis. Uveitis is 4 times more common in women than men, and approximately 75 percent of those who develop uveitis also have a form of arthritis.   Both eyes are commonly affected and the condition tends to be chronic.  

Treatments

Noninfectious uveitis is an inflammation of the eye, and treatment often includes a steroid to reduce that inflammation. The form of steroid (eye drop, pill, or injection) will depend upon the type of uveitis. Uveitis in the front of the eye (anterior) might be treated with steroid eye drops. Other eye drops may also be given to treat pain. Posterior uveitis might not be treatable with eye drops, and a steroid in pill or injection form is often used. Steroids in pill form have a variety of associated side effects and are typically only given in cases that are chronic or are resistant to other treatments.

A newer treatment for chronic uveitis involves inserting an implant behind the eye which dispenses corticosteroids continuously over a period of 2 1/2 years. This treatment may cause cataracts or glaucoma.

In cases where an inflammatory condition such as IBD or arthritis is also present, treating the underlying condition is also recommended.

The Bottom Line

Your eyes are important, and it’s known that IBD can have an effect on them. Seeing your eye doctor on a regular basis is very important. Don’t forget to make your healthcare provider aware of your Crohn’s disease or ulcerative colitis. People with IBD will need to take care to stay on top of eye health. Anything unusual with your eyes or your eyesight should be reported to your practitioners as soon as possible. In this way, you can stay on top of your IBD and your eyesight with the goal of treating any problems quickly before they turn into major problems.

What Is Crohn’s Disease?

Crohn’s disease makes parts of the intestine (bowel) red and swollen. It’s a chronic condition, which means it lasts a long time or constantly comes and goes.

Crohn’s disease is an inflammatory bowel disease (IBD). It can happen in any part of the gastrointestinal tract from mouth to anus (where poop comes out). It most often affects the end of the small intestine and the beginning of the large intestine. The inflammation of Crohn’s disease damages the entire bowel wall.

What Are the Signs & Symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are belly pain and diarrhea. Other symptoms include:

  • blood in the toilet, on toilet paper, or in the stool (poop)
  • nausea or vomiting
  • fever
  • low energy
  • skin tags, sores, or drainage around the anus
  • mouth sores
  • weight loss

Because Crohn’s disease damages the whole bowel wall, there can be scarring, narrowing of the bowel, and fistulas. A fistula (FISS-chuh-luh) is an abnormal connection that links the bowel to the skin, bladder, vagina, or other loops of bowel. A fistula may leak stool (poop), pus, or blood.

Crohn’s disease can cause other problems, such as rashes, eye problems, joint pain and arthritis, kidney stones, and gallstones. Children with Crohn’s disease may not grow as well as other kids their age and may go through puberty later.

What Causes Crohn’s Disease?

The exact cause of Crohn’s disease is not clear. It is probably a combination of genetics, the immune system, and something in the environment that triggers inflammation in the gastrointestinal tract. Diet and stress may make symptoms worse, but probably don’t cause the condition.

Crohn’s disease tends to run in families. But not everyone with the condition has a family history of Crohn’s or IBD. Crohn’s disease can happen at any age, but is usually diagnosed in teens and young adults. People who smoke are more likely to get it..

How Is Crohn’s Disease Diagnosed?

Doctors diagnose Crohn’s disease with a combination of blood tests, stool (poop) tests, and X-rays. They will check stool samples for blood. They also might do imaging tests, such as CT scans and MRI, might be done too.

Doctors can look at the colon using an endoscope, a long, thin tube with a camera attached to a TV monitor:

  • In a colonoscopy, the tube goes in through the anus.
  • In an upper endoscopy, the tube passes down the throat.

The doctor can see inflammation, bleeding, or ulcers in the esophagus, stomach, small intestine and on the wall of the colon. During the procedure, the doctor might do a biopsy, taking small tissue samples for testing in a lab.

How Is Crohn’s Disease Treated?

Crohn’s disease is treated with medicines, changes in diet, and sometimes surgery. The goal of treatment is to relieve symptoms, prevent other problems and flare-ups, and possibly heal the inflamed intestines.

The doctor may recommend:

  • anti-inflammatory drugs to decrease the inflammation
  • immunosuppressive agents to prevent the immune system from causing more inflammation
  • biologic agents to block proteins that cause inflammation
  • nutrition therapy to give the bowel a chance to heal

Because some medicines make it harder to fight infections, it’s important that your child be tested for tuberculosis and have all the recommended vaccines before starting treatment.

Doctors may prescribe antibiotics to prevent or treat infections. People with Crohn’s disease should always check with their doctor before using antidiarrheal medicine.

Poor appetite, diarrhea, and poor digestion of nutrients can make it hard for someone with the condition to get the calories and nutrients they need. Kids should eat a variety of foods, get plenty of fluids, and learn to avoid foods that make symptoms worse. Some may need supplements, like calcium or vitamin D. Kids who are not growing well may need special formulas to boost calories and nutrition.

Surgery may be necessary if:

  • the bowel gets a hole
  • the bowel becomes blocked or narrowed
  • a fistula forms
  • bleeding can’t be stopped
  • symptoms don’t respond to treatment

What Else Should I Know About Crohn’s Disease?

People with Crohn’s disease are at risk for colon cancer, which is related to chronic inflammation. So they should get a colonoscopy every 1–2 years, starting about 10 years after diagnosis.

Kids and teens with Crohn’s disease may feel different and not be able to do the things their friends can do, especially during flare-ups. Some struggle with a poor self-image, depression, or anxiety. They may not take their medicine or follow their diet. It’s important to talk to your health care professional if you’re concerned about your child’s mood, behavior, or school performance.

Parents can help teens with Crohn’s disease can take on more responsibility for their health as they get older. Encourage teens to take their medicine, take care of themselves, and manage stress in positive ways. Yoga, meditation, breathing and relaxation techniques, music, art, dance, writing, or talking to a friend can help.

You also can find more information and support online at:

What Is Crohn’s Disease?

Crohn’s disease is a condition that causes parts of the intestine (bowel) to get red and swollen. It’s a chronic condition, which means it lasts a long time or constantly comes and goes.

Crohn’s disease is an inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract from mouth to anus (where poop comes out). It’s most commonly found at the end of the small intestine and the beginning of the large intestine. The inflammation of Crohn’s disease damages the entire bowel wall.

What Are the Signs & Symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are belly pain and diarrhea. Other symptoms include:

  • blood in the toilet, on toilet paper, or in the stool (poop)
  • nausea or vomiting
  • fever
  • low energy
  • skin tags, sores, or drainage around the anus
  • mouth sores
  • weight loss

Because Crohn’s disease damages the whole bowel wall, there can be scarring, narrowing of the bowel, and fistulas. A fistula (pronounced: FISS-chuh-luh) is an abnormal connection that links the bowel to the skin, bladder, vagina, or other loops of bowel. A fistula may leak stool (poop), pus, or blood.

Crohn’s disease can cause other problems, such as rashes, eye problems, joint pain and arthritis, and kidney stones and gallstones.

What Causes Crohn’s Disease?

The exact cause of Crohn’s disease is not clear. It is probably a combination of genetics, the immune system, and something in the environment that triggers in the gastrointestinal tract. Diet and stress may make symptoms worse, but probably don’t cause Crohn’s disease.

Crohn’s disease tends to run in families. But not everyone with Crohn’s disease has a family history of IBD. Crohn’s disease can happen at any age, but is usually diagnosed in teens and young adults. People who smoke are more likely to get Crohn’s disease.

How Is Crohn’s Disease Diagnosed?

Doctors diagnose Crohn’s disease with a combination of blood tests, stool (poop) tests, and X-rays. They also might do imaging tests, such as CT scans and MRIs.

Doctors can look at the colon using an endoscope, a long, thin tube with a camera attached to a TV monitor:

  • In a colonoscopy, the tube goes in through the anus.
  • In an upper endoscopy, the tube passes down the throat.

The doctor can see inflammation, bleeding, or ulcers in the esophagus, stomach, small intestine and on the wall of the colon. During the procedure, the doctor might do a biopsy, taking small tissue samples for testing in a lab.

How Is Crohn’s Disease Treated?

Crohn’s disease is treated with medicines, changes in diet, and sometimes surgery. The goal of treatment is to relieve symptoms, prevent other problems and flare-ups, and possibly heal the inflamed intestines.

Your doctor may recommend:

  • anti-inflammatory drugs to decrease the inflammation
  • immunosuppressive agents to prevent the immune system from causing more inflammation
  • biologic agents to block proteins that cause inflammation
  • nutrition therapy to give the bowel a chance to heal

Surgery may be necessary if:

  • the bowel gets a hole
  • the bowel becomes blocked
  • a fistula forms
  • bleeding can’t be stopped
  • symptoms don’t respond to treatment

Nutrition therapy is a way to treat Crohn’s disease with a special diet. A person with Crohn’s disease gets a drinkable formula instead of eating regular food. This diet can reduce inflammation and help heal the intestines. Sometimes, nutrition therapy is used instead of medicine. A doctor or registered dietitian can create these diets.

Doctors may prescribe antibiotics to prevent or treat infections. People with Crohn’s disease should always check with their doctor before using antidiarrheal medicine.

Because some medicines make it harder to fight infections, it’s important to get tested for tuberculosis and have all the recommended vaccines before starting treatment.

Poor appetite, diarrhea, and poor digestion of nutrients can make it hard for someone with the condition to get the calories and nutrients they need. Be sure to eat a variety of foods, get plenty of fluids, and avoid foods that make your symptoms worse. Some teens may need supplements, like calcium or vitamin D. Someone who isn’t growing well may need other nutrition support.

What Else Should I Know?

Dealing with the symptoms of Crohn’s disease can be a challenge. But many people with Crohn’s disease can stay well and have few symptoms for long periods of time. Talk to your doctor about ways you can feel better during flares. Because stress can make symptoms worse, it’s important to get enough sleep and manage stress in positive ways. Yoga, meditation, breathing and relaxation techniques, music, art, dance, writing, or talking to a friend can help.

If you feel sad or anxious about your symptoms, talk to your doctor, parent, or other trusted adult. It may also help to talk to a therapist or other mental health provider.

As you get older, you can take on more responsibility for managing your health care. Getting treatment for Crohn’s disease, managing your symptoms, and keeping a positive attitude can help get you back on track.

You also can find more information and support online at:

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Summary

What is Crohn’s disease?

Crohn’s disease is a chronic disease that causes inflammation in your digestive tract. It can affect any part of your digestive tract, which runs from your mouth to your anus. But it usually affects your small intestine and the beginning of your large intestine.

Crohn’s disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

What causes Crohn’s disease?

The cause of Crohn’s disease is unknown. Researchers think that an autoimmune reaction may be one cause. An autoimmune reaction happens when your immune system attacks healthy cells in your body. Genetics may also play a role, since Crohn’s disease can run in families.

Stress and eating certain foods don’t cause the disease, but they can make your symptoms worse.

Who is at risk for Crohn’s disease?

There are certain factors which can raise your risk of Crohn’s disease:

  • Family history of the disease. Having a parent, child, or sibling with the disease puts you at higher risk.
  • Smoking. This may double your risk of developing Crohn’s disease.
  • Certain medicines, such as antibiotics, birth-control pills, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. These may slightly increase your chance of developing Crohn’s.
  • A high-fat diet. This may also slightly increase your risk of Crohn’s.

What are the symptoms of Crohn’s disease?

The symptoms of Crohn’s disease can vary, depending where and how severe your inflammation is. The most common symptoms include:

  • Diarrhea
  • Cramping and pain in your abdomen
  • Weight loss

Some other possible symptoms are:

  • Anemia, a condition in which you have fewer red blood cells than normal
  • Eye redness or pain
  • Fatigue
  • Fever
  • Joint pain or soreness
  • Nausea or loss of appetite
  • Skin changes that involve red, tender bumps under the skin

Stress and eating certain foods such as carbonated drinks and high-fiber foods may make some people’s symptoms worse.

What other problems can Crohn’s disease cause?

Crohn’s disease can cause other problems, including:

  • Intestinal obstruction, a blockage in the intestine
  • Fistulas, abnormal connections between two parts inside of the body
  • Abscesses, pus-filled pockets of infection
  • Anal fissures, small tears in your anus that may cause itching, pain, or bleeding
  • Ulcers, open sores in your mouth, intestines, anus, or perineum
  • Malnutrition, when your body does not get the right amount of vitamins, minerals, and nutrients it needs
  • Inflammation in other areas of your body, such as your joints, eyes, and skin

How is Crohn’s disease diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, which includes asking about your symptoms
  • A family history
  • A physical exam, including
    • Checking for bloating in your abdomen
    • Listening to sounds within your abdomen using a stethoscope
    • Tapping on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged
  • Various tests, including
    • Blood and stool tests
    • A colonoscopy
    • An upper GI endoscopy, a procedure in which your provider uses a scope to look inside your mouth, esophagus, stomach, and small intestine
    • Diagnostic imaging tests, such as a CT scan or an upper GI series. An upper GI series uses a special liquid called barium and x-rays. Drinking the barium will make your upper GI tract more visible on an x-ray.

What are the treatments for Crohn’s disease?

There is no cure for Crohn’s disease, but treatments can decrease the inflammation in your intestines, relieve symptoms, and prevent complications. Treatments include medicines, bowel rest, and surgery. No single treatment works for everyone. You and your health care provider can work together to figure out which treatment is best for you:

  • Medicines for Crohn’s include various medicines that decrease the inflammation. Some of these medicines do this by reducing the activity of your immune system. Medicines can also help with symptoms or complications, such as nonsteroidal anti-inflammatory drugs and anti-diarrheal medicines. If your Crohn’s causes an infection, you may need antibiotics.
  • Bowel rest involves drinking only certain liquids or not eating or drinking anything. This allows your intestines to rest. You may need to do this if your Crohn’s disease symptoms are severe. You get your nutrients through drinking a liquid, a feeding tube, or an intravenous (IV) tube. You may need to do bowel rest in the hospital, or you may be able to do it at home. It will last for a few days or up to several weeks.
  • Surgery can treat complications and reduce symptoms when other treatments are not helping enough. The surgery will involve removing a damaged part of your digestive tract to treat
    • Fistulas
    • Bleeding that is life threatening
    • Intestinal obstructions
    • Side effects from medicines when they threaten your health
    • Symptoms when medicines do not improve your condition

Changing your diet can help reduce symptoms. Your provider may recommend that you make changes to your diet, such as:

  • Avoiding carbonated drinks
  • Avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
  • Drinking more liquids
  • Eating smaller meals more often
  • Keeping a food diary to help identify foods that cause problems

Some people also need go on special diet, such as a low-fiber diet.

National Institute of Diabetes and Digestive and Kidney Diseases

Even more surprising than the association between arthritis and eye inflammation, at least to some people, is the association between bowel inflammation and eye inflammation. But history tells us that such an association exists. This may be true not only in infectious inflammatory bowel disease, as in the case of Whipple’s disease, but also in inflammatory bowel disease(IBD) generally considered to be autoimmune. For example, approximately 5% of patients who develop ulcerative colitis will experience episodes of recurrent uveitis; some patients with ulcerative colitis will develop other ocular inflammation such as scleritis or episcleritis. And an even greater association exists between Crohn’s disease (regional ileitis) and ocular inflammation. Interestingly, the “activity” of the inflammation in the eye and the inflammation in the gut rarely are concurrent, i.e., the inflammatory bowel disease may be under excellent control, but uveitis may be extremely troublesome, and vice versa, the eye may not have any difficulty at all, while the patient is having major flare-ups of inflammatory bowel disease. Additionally, one of the more effective medications for control of the inflammatory bowel disease activity, Sulfasalazine, has proven to be, in our hands and in those of others, particularly disappointing in controlling the recurrent episodes of uveitis in patients with inflammatory bowel disease-associated uveitis. Patients with IBD associated uveitis generally required one of the immunomodulatory medications, such as Methotrexate, Azathioprine,or Cyclosporin and in some cases may need to have biologic therapy, such as Remicade or Humira.

In contrast, patients with “irritable bowel syndrome” associated uveitis can often be managed with topical therapy or with sulfasalazine or an oral non-steroidal anti-inflammatory agent without the need of a immunosuppressant/immunomodulatory agent. The exact connection between “irritable bowel syndrome” (as opposed to inflammatory bowel disease), and uveitis is not well proven, but it has been the strong clinical impression of many experts of uveitis that such an association exists.

Without treatment, symptoms of Crohn’s disease can be constant or may come and go every few weeks or months.

When the symptoms come back, it’s called a flare-up or relapse. The periods between flare-ups are called remission.

Common symptoms

The main symptoms of Crohn’s disease are:

  • diarrhoea – which may come on suddenly
  • stomach aches and cramps – most often in the lower-right part of your tummy
  • blood in your poo
  • tiredness (fatigue)
  • weight loss

You might not have all these symptoms.

Other symptoms

Some people with Crohn’s disease also have:

  • a high temperature
  • feeling and being sick
  • joint pains
  • sore, red eyes
  • patches of painful, red and swollen skin – usually on the legs
  • mouth ulcers

Children with Crohn’s disease may grow more slowly than usual.

When to see a GP

See a GP if you or your child have:

  • blood in your poo
  • diarrhoea for more than 7 days
  • frequent stomach aches or cramps
  • lost weight for no reason, or your child is not growing as fast as you’d expect

A GP will try to find out what’s causing your symptoms and may refer you for tests to check for Crohn’s disease.

Page last reviewed: 22 April 2021
Next review due: 22 April 2024

How to manage eye disorders with crohn's disease

Doctors of optometry add value to the team of health professionals who manage cases of inflammatory bowel diseases (IBDs) and colonic malignancies.

Extraintestinal manifestations of these conditions in the eye present a unique opportunity to doctors of optometry to identify exacerbations of IBDs during comprehensive eye examinations, reports a newly released AOA Health Policy Institute (HPI) brief. Given that comprehensive eye examinations can lead to earlier, definitive diagnosis of IBD, patient outcomes improve with earlier treatment.

“The clinical manifestations of common inflammatory bowel diseases (IBDs), including Crohn’s disease and ulcerative colitis, are not restricted to the gastrointestinal tract,” the HPI paper states. “IBDs have impact to other organs in a significant number of patients, including the eyes in 72.1% of patients with IBDs.

“These manifestations, known as extraintestinal manifestations (EIMs), associated with the eyes, include inflammatory changes in blood vessels of the conjunctiva and sclera (i.e., white part of the eye), and ciliary body (i.e., underbody to the iris, the colored part of the eye),” the authors write. “Left untreated, these manifestations can cause temporary and/or permanent vision loss.”

HPI is the thought leader in public policy research and analysis focused on eye health and vision care. Drawing on its expertise, HPI develops creative, innovative and educational resources and tools to inform policymakers, health care professionals, patients and the public. Its solutions illuminate best policies for efficient access to and delivery of high-quality, comprehensive eye health and vision care.

Prevalence of IBD

According to the Centers for Disease Control and Prevention (CDC), a growing number of Americans have been diagnosed with IBD.

In 1999, IBD prevalence was 2 million American adults, according to the CDC. In 2015, using a more nationally representative study population, about 3.1 million adults reported receiving a diagnosis of IBD.

The brief links IBD’s inflammation to a variety of ophthalmic conditions, including:

  • Episcleritis
  • Scleritis
  • Keratoconjunctivitis sicca (dry eye)
  • Retinal edema
  • Optic neuritis (swelling of the optic nerve)
  • Extraocular muscle nerve palsies.

“All of these manifestations can range in severity from mild to severe, can be temporary or permanent, and can cause significant loss of quality of life and be visually disabling,” the HPI brief reads. “The most common ocular complication associated with bowel disease is dry eye syndrome, one of the most common diseases of the human eye.

“Evaluation of the eye should be a routine component of care in patients with IBD just as it is with similar chronic co-morbid systemic conditions like diabetes,” the brief adds. “The doctor of optometry has the ability to provide personalized feedback to both the patient and the interprofessional health care team regarding any IBD prescribed drug therapies (i.e., aminosalicylates). This feedback is important as these therapies may cause several ocular side effects, including, but not limited to change in distance and near vision.”

Further, a dilated eye examination can detect colonic malignancies with extracolonic manifestations (such as familial adenomatous polyposis or FAP) in the form of congenital hypertrophy of the retinal pigment epithelium, the brief says.

Comprehensive eye examinations

Optometry’s capacity to diagnose IBD early, via comprehensive eye exams, underscores its capacity to improve health outcomes in team-based medical management.

“A comprehensive eye examination must consider the whole patient and that is precisely why the first two years of medical, osteopathic and optometry school curricula are the same,” says Michael Dueñas, O.D., AOA chief public health officer, “The gastroenterological conditions presented in this HPI brief represent just a sample of over 276 systemic diseases that have ocular involvement.”

He adds, “This reinforces the need for the comprehensive eye exam, offered by a doctor of optometry, to be viewed as an integral part of a patient’s essential episodic primary care experience.”

November 22, 2019

Approximately 700,000 individuals in the United States live with Crohn’s disease. It is still unknown what causes it, but researchers believe that it may be caused by an infection, that even after being cleared, triggers an immunological response.

Crohn’s disease is an inflammatory disease of the gut. It is currently not curable. The symptoms may come and go, but once you’ve been diagnosed with the condition, you will need to effectively manage the symptoms for the rest of your life. Crohn’s disease symptoms that are left unmanaged can result in serious health consequences and a lot of unpleasant symptoms.

Crohn’s disease symptoms develop gradually. If you exhibit the first signs of Crohn’s disease, you should see a gastroenterologist as soon as possible. Crohn’s disease symptoms will only get worse with time. The sooner you learn to manage your symptoms and the condition, the easier it will be to live with the condition with the least amount of impact on your life.

Early Signs of Crohn’s Disease

With Crohn’s disease, your body attacks the healthy cells in the intestinal lining. It can be difficult to pinpoint the condition if you do not look out for the signs. Some of the earliest signs include:

  • Appetite loss
  • Abdominal pain
  • Fever
  • Exhaustion
  • Joint pain
  • Nausea
  • Pain and redness in eyes
  • Red bumps on the skin

These symptoms may seem unrelated or harmless on their own, and it is easy to ignore them. However, if you experience more than a few of them, it could be a sign of Crohn’s disease. Once the condition worsens, symptoms will include:

  • Bloody stools
  • Black, paste-like stools
  • Diarrhea that doesn’t respond to medication
  • Mouth sores
  • Weight Loss
  • Pain in or around the anus
  • Anal drainage
  • Bleeding rectum
  • Inflammation of the liver
  • Developmental delays in children

People with Crohn’s disease find their symptoms exacerbate after eating certain foods or periods of high stress. However, they may also experience periods of remission where their symptoms go away completely for several weeks, months, or even years at a time.

Crohn’s Disease Symptom Management

Symptoms of Crohn’s disease can be debilitating and prevent you from participating in and enjoying activities you love. A gastroenterologist can diagnose your condition and create a treatment plan for Crohn’s symptoms management. With a combination of a healthy diet and lifestyle, anti-inflammatory medication, and antibiotic medication, you can prevent Crohn’s disease from taking a heavy toll on your body.

Crohn’s disease can also increase your risk of getting colon cancer. For this reason, your gastroenterologist may recommend screenings for colon cancer.

Crohn’s Disease Diagnosis and Treatment in Ohio

If someone in your family was diagnosed with Crohn’s disease, you may be at risk of developing the disease, as well.

The highly-experienced and compassionate gastroenterology team at North Shore Gastroenterology diagnoses and treats all types of disorders that affect the digestive system, including inflammatory bowel diseases like Crohn’s disease.

If you are experiencing any unusual symptoms, call North Shore Gastroenterology at (440) 808-1212 or request an appointment now. Our friendly team looks forward to serving you in our offices in Westlake and Brooklyn, Ohio.

  • Medical Reviewer: Poonam Sachdev, MD

How to manage eye disorders with crohn's disease

Crohn’s disease, a type of irritable bowel syndrome (IBD), is linked to a number of eye problems. But most medical reports don’t formally link Crohn’s disease and dark eyes or list dark circles around your eyes — also called periorbital pigmentation — as a symptom.

However, other symptoms of Crohn’s disease have been linked to dark eye circles. These include anemia, a condition where you have low iron levels in your blood. One study found that 10% of participants with excessive dark circles had anemia.

So, if you’ve been diagnosed with Crohn’s disease and have recently developed dark circles around your eyes, then anemia is a potential cause.

In addition, simply having Crohn’s disease can increase people’s stress levels. Increased stress can lead to a loss of sleep, which is the number one cause of dark circles around people’s eyes.

What eye problems are common symptoms of Crohn’s disease?

Eye problems occur in approximately 10% of all people with an IBD. Almost all of these symptoms are treatable and won’t result in any permanent vision loss.

In Crohn’s disease, symptoms such as sudden pain, redness, and changes to your vision can set in quickly. Eye symptoms tend to be the most obvious during inflammation flare-ups and when your Crohn’s disease is localized in your colon. One study also indicates that eye symptoms are more common in younger populations with the condition.

You can also develop one of a handful of eye conditions thanks to this disease. Most of these are linked to some form of inflammation in your eye. They include:

  • Uveitis. A condition that causes redness, pain, light sensitivity, and blurred vision. It tends to clear up when your IBD is under control. But your doctor may also prescribe corticosteroid eye drops to lower inflammation since the condition can become serious if left untreated.
  • Keratopathy. This condition leads to white deposits around the edges of your cornea and develops specifically in some people with Crohn’s. The symptoms are generally unnoticeable and you won’t need any treatment.
  • Episcleritis. A condition where the outer coating of the white of your eye, called the episclera, becomes inflamed. Your blood vessels dilate and the area turns red. The condition may clear up when your Crohn’s flare-up recedes but you could need steroid eye drops for treatment.
  • Dry Eyes. Results from of lack of tears and comes with an increased risk of irritation, infection, and night blindness. Vitamin Asupplements are an effective treatment and artificial tears can help relieve your symptoms.

Other areas of your eye can become inflamed from your IBD. These areas are less common but do include your retina and optic nerve.

It’s also possible for some of the medications that you need to treat Crohn’s disease to cause eye problems on their own. For example, long-term corticosteroid use could cause you to develop glaucoma — a condition which can severely limit your vision.

What are other causes of dark circles around your eyes?

You could have another underlying condition or situation, independent from your Crohn’s diagnosis, that’s contributing to the dark circles under your eyes. Examples of these possibilities include:

  • Changes to your sleep schedule — particularly a loss of sleep
  • Low levels of vitamin B12
  • Problems with allergens
  • A family history of these dark circles
  • Certain habits, like frequently rubbing your eyes or spending large amounts of time in front of a computer screen

In some of these cases, simple changes to your habits or diet will help relieve your dark eye circles. You can also consult your doctor if the discoloration is persistent.

What is Crohn’s disease?

Crohn’s disease is one of many inflammatory bowel diseases, all of which create inflammation in some portion of your gastrointestinal (GI) tract. Your GI tract stretches all the way from your mouth, down through your stomach, out the duodenum, and into your intestines, finally ending at the anus.

Approximately half a million people in the U.S. have Crohn’s disease. There are five different categories of Crohn’s disease that are distinct because of where they cause inflammation along your GI tract. You can, for example, have a version of Crohn’s disease in your stomach.

But Crohn’s disease most commonly causes inflammation in your small intestine and the beginnings of your colon (large intestine). It tends to be patchy, so you’re likely to have areas of healthy tissue in between spots of inflammation.

Current theories state that Crohn’s disease is an autoimmune disorder where your body mistakes bacteria in your intestine for a threat. It causes inflammation in response to this threat.

Common symptoms of Crohn’s disease in the GI tract

Some symptoms are common to most types of Crohn’s disease. These are mostly because of the inflamed tissues. They include:

  • Diarrhea
  • Pain and cramps in your abdomen
  • Weight loss
  • Bleeding from your rectum
  • Feeling an urgent need to have a bowel movement
  • The feeling that you haven’t completely emptied your bowels

How to manage eye disorders with crohn's disease

SLIDESHOW

What are other symptoms of Crohn’s outside of the intestine?

Like the eye problems discussed above, Crohn’s disease can have a large number of other symptoms that are outside of the GI tract. These include:

  • Anemia
  • Increased feelings of tiredness and exhaustion
  • Fever
  • Pain in your joints
  • Nausea
  • Loss of appetite
  • Red, tender bumps forming under some areas of your skin
  • Mouth sores
  • Weight loss
  • Night sweats
  • Kidney stones
  • Changes to your menstrual cycle
  • Osteoporosis

Some of these may be due to problems with nutrient absorption due to the complications in your GI tract.

When should you talk to your doctor?

Dark circles around your eyes aren’t usually a major cause for concern. Simply noticing dark circles doesn’t mean that you need to seek medical attention, but it could be worth mentioning at your next doctor’s appointment.

Crohn’s disease, however, is a serious condition that can lead to many long-term health consequences if left untreated. Be sure to talk to your doctor as soon as possible if you are experiencing any of the common symptoms of Crohn’s disease, particularly persistent diarrhea and pain from intestinal inflammation.

A lot of signs point to nutrient deficiencies.

How to manage eye disorders with crohn's disease

If you’ve recently been diagnosed with Crohn’s disease, chances are you haven’t thought about how it can affect parts of the body beyond the bowels. After all, abdominal pain and diarrhea are hallmark symptoms. Crohn’s disease most commonly affects the ileum, which is the end of the small bowel and the beginning of the colon. But inflammation from the illness can spread elsewhere, including the eyes, skin, and joints.

“When Crohn’s becomes active, inflammation can lead to other areas of the body. The gastrointestinal tract involves the organs from mouth to anus, so it’s no surprise that these areas can also be affected,” says Shannon Chang, MD, a gastroenterologist who specializes in Crohn’s and ulcerative colitis at NYU Langone.

The disease can also cause lead to malabsorption of nutrients that are vital to the function of several organs, so if you’re lacking iron, vitamin D, and calcium, for example, your energy levels, bones, and brain health might suffer. Here are other classic symptoms of and ways to detect Crohn’s disease:

How to manage eye disorders with crohn's disease

People with Crohn’s disease may be deficient in vitamin A, which is important for maintaining healthy vision. Because of this, many Crohn’s patients experience blurred vision and dry eyes, which can lead to redness, irritation, and burning.

Uveitis and episcleritis are two other common eye complications of Crohn’s, says Dr. Chang. Uveitis is inflammation in the uvea—the middle layer of the eye wall, while episcleritis is inflammation of the outer coating of the white of the eye, aka the episclera.

“They [uveitis and episcleritis] can both cause pain in the eye and inflammation, so it’s important that patients see an ophthalmologist immediately if they have symptoms,” she says.

How to manage eye disorders with crohn's disease

People living with Crohn’s can develop mouth ulcers and canker sores, also known as aphthous stomatitis. These sores can show up in the gums and lower lip as well as the sides of the mouth and the base of the tongue. Dr. Chang says patients sometimes experience them during a flare. “The best way to treat these symptoms is to treat the Crohn’s, because other treatments for the sores themselves are just short-term relief,” Dr. Chang says. Some doctors also recommend using a prescribed mouthwash to tame the infection and certain multivitamin supplements to help treat the deficiency.

How to manage eye disorders with crohn's disease

“Erethema nodosum are red welts on the legs that can vary in size, but they’re roughly the size of a dime and bigger than hives,” Dr. Chang says. These red welts can also appear on the shins, ankles, and arms. Like several of the symptoms on this list, many people with Crohn’s experience erethema nodosum when they have a flare-up. Some Crohn’s patients may also develop pyoderma gangrenosum, which are pus-filled skin lesions in the shins or ankles, but people can develop them in the arms, too. While they may start as small clusters of blisters, they can join together to form deep ulcers. The treatment is to get your Crohn’s under control, but your doctor may also prescribe topical creams and antibiotics.

How to manage eye disorders with crohn's disease

Chronic diarrhea and painful bowel movements can cause anal fissures in people with Crohn’s. Anal fissures are small tears in the tissue that lines the anus. Inflammation from Crohn’s can also lead to anal fissures, even without any bowel issues.

How to manage eye disorders with crohn's disease

You’re more likely develop vitamin D and calcium deficiencies with Crohn’s, so many people with the condition may also have osteoporosis. “When the ileum is inflamed, it’s hard for your body to absorb vitamin D, and malabsorption of vitamin D prevents calcium from being absorbed into the bones,” explains Ellen Scherl, MD, director of the Jill Roberts IBD Center at New York Presbyterian Hospital/Weill Cornell Medicine.

“Joint complaints can be migratory, so it can lead from part of the body to another,” Dr. Scherl says. For example, back pain is a common complaint, but Crohn’s patients can also have stiffness in the wrists, hips, and knees. Dr. Chang recommends treating joint pain with heat, ice, and stretching but to stay away from NSAIDs as they can affect Crohn’s in the gut. Dr. Scherl and Dr. Chang both say that doctors will also order x-rays to rule out stress fractures and rheumatic disorders, which are common in Crohn’s patients.

How to manage eye disorders with crohn's disease

Another classic example of how malabsorption of nutrients can lead to a Crohn’s complication, fatigue, or anemia is due to an iron deficiency. “Iron deficiency can also be a result of blood loss from active bleeding with colitis and anal fistulas, which are small openings or tunnels that form inside the anus to an opening on the skin around the anus,” Dr. Scherl explains. Dr. Scherl also says there tends to be an overlap with celiac disease and Crohn’s, so having celiac disease can also affect the way your body absorbs iron—and vitamin C, which helps your body to take in iron.

How to manage eye disorders with crohn's disease

Unexpected weight loss is a classic sign of Crohn’s disease. “We have to ask patients if it’s because they’re not eating because they get gassy or start cramping or vomiting. A lot of patients just don’t eat because they’re afraid of how the food will affect them,” Dr. Scherl says.

Dietitians working with people living with Crohn’s generally recommend a low-fiber diet with limited processed foods, especially for those with strictures or narrowing in their bowels. But if you don’t have strictures, “we like to recommend a diet filled with plenty of anti-inflammatory foods, like vegetables and fruits, lean protein, and whole grains,” Dr. Chang says. It’s a common misconception that you shouldn’t have fiber if you have Crohn’s, but it depends on your condition.

Rapid Response:

Kalla et al discussed the clinical review of Crohn’s disease. (1) Ophthalmic manifestations have been reported to occur in up to 12% of patients with Crohn’s disease. (2) Episcleritis and uveitis, are well-recognised extra-intestinal manifestations, (3) nonspecific follicular conjunctivitis, blepharitis and lid swelling can also occur. (4) orbital myositis ( 5) and optic neuritis (6) are rare ocular complications. Treatment of intestinal inflammation, either medically or surgically, usually aids resolution of ophthalmic complications.(7) It is important to consider an ophthalmic evaluation when a patient with Crohn’s disease presents with an eye symptom.

1. Kalla R, Ventham N, Satsangi J, Arnott I. Crohn’s disease-clinical review. BMJ 2014; 349.

2. Felikis T, Katsanos K, Kitsanou M, Trakos N, Theopis- Tos V, Christodoulou D, Asproudis I,Tsianos EV. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single center study. Inflamm Bowel Dis 2009; 15: 29-34.
3. Taylor SR, McCluskey P, Lightman S. The ocular manifestations of inflammatory bowel disease. Curr Opin Ophthalmol. 2006;17:538–544.
4. Cheng S, Vu P. Recurrent orbital myositis with radiological feature mimicking thyroid eye disease in a patient with Crohn’s Disease. Orbit 2009; 28: 368–370.
5. Culver EL, Salmon JF, Frith P, Travis SPL. Recurrent posterior scleritis and orbital myositis as extra-intestinal manifestations of Crohn’s disease: Case report and systemic literature review. J Crohn’s Colitis. 2008; 337–342.
6. Malik A, Zakri R, Sheikh Z, Shalchi Z, Zia R, Schultz D. Concurrent macular oedema and optic neuritis in Crohn’s disease with varied response to steroids. BMJ Case Rep. 2010; 2010

7. Ghanchi FD, Rembacken BJ. Inflammatory bowel disease and the eye. Surv Ophthalmol 2003; 48: 663–676.

Competing interests: No competing interests

Crohn’s Disease, Ulcerative Colitis, and IBD Complications

Crohn’s disease and ulcerative colitis are often difficult to manage. They are best treated by gastroenterologists who specialize in these inflammatory bowel diseases. Duke’s team of inflammatory bowel disease specialists helps you manage your IBD, and gets your disease back into remission if you have a relapse.

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Whether your disease is mild or complex, our gastroenterologists who specialize in IBD treatment can work with you to control your disease and its symptoms. We help restore your quality of life and watch for any complications related to the disease or its treatment.

Expertise in Diagnosing and Treating IBD
Doctors from across the region refer their patients to us because of our expertise in diagnosing and treating IBD and its complications. If you are referred to us, we will partner with your current doctors to ensure you receive the best possible care. We also welcome people who are new to the Triangle and want to establish care with an experienced IBD provider.

Experience with Complicated Conditions
Whether you are newly diagnosed with Crohn’s or ulcerative colitis, or are seeking another opinion about your treatment, our IBD providers are ready to see you. We work with people who:

  • Have complex IBD histories
  • Have other medical problems that make their treatment challenging
  • Are not responding to conventional treatments
  • Have developed a complication related to IBD or its treatment and require more comprehensive care

Post-Surgery Treatment
We provide care for people with Crohn’s who have had surgery to remove a piece of intestine or close a fistula. We also help people with ulcerative colitis who have undergone surgery to “cure” the disease by removing their colon. And we can help with managing “pouchitis,” an inflammation of the ileal pouch that may occur after removal of the colon.

Many think the abdominal disorder starts in childhood, but it can occur at any age and is becoming more prevalent throughout the world.

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How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

Shelley Martin, a Manhattan accountant, was in her mid-60s when she learned after a routine colonoscopy that she had Crohn’s disease, a chronic inflammatory disorder characterized by abdominal pain and diarrhea. She said when friends learned of her diagnosis, several said “How can that be? Crohn’s starts in childhood.”

Actually, this often debilitating disease, which typically affects the area where the small intestine joins the colon, can occur at any age. “If you’re born with the right genetics, it can first appear in young kids to people in their 80s or 90s,” said Dr. Joseph D. Feuerstein, gastroenterologist at Beth Israel Deaconess Medical Center in Boston. “It’s rising in incidence and prevalence throughout the world,” he said, and gastroenterologists are still trying to figure out why it shows up when it does in different people.

Crohn’s disease was first described in 1932 by Dr. Burrill B. Crohn and colleagues and is one of two chronic inflammatory bowel diseases (ulcerative colitis is the other) that have no specific cause. Together, they afflict about three million people in the United States. Crohn’s in adults starts on average at age 30, with peak incidence between ages 20 and 30 and a second peak around age 50. The disease tends to run in families, but the genetic risk is not large. One in 10 to one in four patients have a close family member who is affected, and only half of identical twin pairs get it.

In decades past, Crohn’s was thought to primarily afflict people of Ashkenazi Jewish descent, but “we’re now seeing it everywhere — in Asia, Latin America, all over the world,” said Dr. Feuerstein.

Experts speculate that its rise is somehow linked to industrialization and a Western-style diet rich in meats and processed foods. Some suggest a link to living in an overly hygienic environment that may prompt the immune system to attack the body’s healthy tissues instead of infectious organisms.

And even though the bowel is the disease’s most prominent target, “it can also involve the eyes, joints, liver, skin,” said Dr. Gary R. Lichtenstein, gastroenterologist at the University of Pennsylvania School of Medicine. “It’s not one distinct disorder — over 200 genes have been identified as associated with Crohn’s. It results from a complex interaction between the environment and genetics” and can be initiated by an individual’s response to exposures ranging from infectious agents to medications.

Two well-established instigators are the frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, and cigarette smoking. Both can trigger onset of the disease or cause flare-ups in those who already have it, Dr. Lichtenstein said. In fact, he said, smoking not only creates a greater risk of developing Crohn’s, it can also result in a more virulent course of the disease.

Unlike Ms. Martin, who had no inkling anything was wrong until her routine colon exam, most people with Crohn’s have unexplained symptoms for many months or even years before the correct cause is determined. Following the diagnosis, she said she developed “mild but annoying diarrhea,” but she considers herself relatively lucky given the potential complex of symptoms associated with Crohn’s.

In addition to abdominal pain and diarrhea that can be bloody, possible signs and symptoms include unexplained weight loss, anemia, fever, fatigue, nausea and vomiting, loss of appetite, eye and joint pain and tender, red bumps on the skin. In children, the disease can result in a failure to grow.

Prompt diagnosis and appropriate therapy to suppress inflammation in the digestive tract are extremely important because a delay can result in scar tissue and strictures that are not reversed by medication, Dr. Feuerstein said. Another possible serious complication is development of a fistula — an abnormal connection between different organs, like the colon and bladder, requiring surgical repair that, in turn, can cause further intestinal damage.

Understandably, considerable stress, anxiety and depression can accompany the disease and may even cause a worsening of symptoms. Last summer, when Ms. Martin’s disease suddenly raged out of control after she was treated with a drug to keep breast cancer at bay, severe diarrhea kept her tied to the bathroom in her Manhattan apartment. Dr. Lichtenstein said the class of drugs Ms. Martin took, called checkpoint inhibitors, is especially challenging to Crohn’s patients who may have to choose between trying to prevent a recurrence of cancer and suppressing their intestinal disease because the cancer drugs can sometimes cause an inflamed colon.

If severe inflammation and debilitating symptoms are present when Crohn’s is diagnosed, patients are usually treated with steroids to bring the disease under control before they are placed on medication specific for the condition. “Steroids,” Dr. Feuerstein said, “are a Band-Aid to arrest the inflammatory process, but then we have to do something to suppress the disease and allow the body to heal.”

Sometimes before starting medication, patients are temporarily placed on a restricted liquid diet to rest the bowel and give it a chance to heal, said Dr. Lichtenstein, the lead author of the latest management guidelines for Crohn’s disease developed by the American College of Gastroenterology.

There are now multiple drug options for treating Crohn’s, although keeping symptoms under control often involves trial and error. For example, following Ms. Martin’s diagnosis five years ago, the specialist she consulted told her there were four possible oral drugs to try in succession. Each worked for several months, but after the fourth drug no longer relieved her symptoms, she was given an infusion of a remedy called Entyvio, which she said “worked immediately like a miracle.”

Entyvio, the trade name for vedolizumab, is what’s known as a biologic, a drug made from living cells that is typically given by infusion or injection, one of several such drugs now available for Crohn’s. It acts specifically on the gut to counter inflammation, and with her colon still inflamed, Ms. Martin needs to be treated with the drug every four weeks. If this one stops working, she can try one of the others.

Ms. Martin knows, however, that Crohn’s is not curable and most patients have to stay on medication indefinitely. That can create yet another stumbling block. The biologics are very costly, averaging over $100,000 a year, and although they are usually covered by insurance, there is a steep co-payment. To afford the therapy, many patients depend on co-pay assistance programs administered by the drug companies, Dr. Feuerstein said.

However, as Ms. Martin recently learned, Medicare will cover the expense if she gets the infusion in a hospital or if her doctor can arrange for a nurse to come to her home to administer the drug.

Last Updated January 2021 | This article was created by familydoctor.org editorial staff and reviewed by Kyle Bradford Jones

Table of Contents

How to manage eye disorders with crohn's disease

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is the name of a group of disorders that cause the intestines to become inflamed (red and swollen). The inflammation lasts a long time before subsiding, but it usually comes back over and over again. Approximately 1.6 million Americans have some kind of inflammatory bowel disease.

The two primary types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis.

What is Crohn’s disease?

Crohn’s disease is an IBD that causes ulcers to form in the gastrointestinal (GI) tract anywhere from the mouth to the anus. Crohn’s disease can have “skip” areas that are normal. These normal areas lie in between areas that are affected. Some people who have Crohn’s disease have severe symptoms. Others have symptoms that are not as severe. Some people who have the disease have long periods without symptoms, even without getting treatment. Others who have more severe symptoms will need long-term treatment or even surgery.

What is ulcerative colitis?

Ulcerative colitis is an IBD that causes your colon (large intestine) to become red and swollen. The redness and swelling can last for a few weeks or for several months. Ulcerative colitis always involves the last part of the colon (the rectum). It can go higher up in the colon, up to involving the whole colon. Ulcerative colitis never has the “skip” areas typical of Crohn’s disease. Symptoms may come and go. These occurrences are called flare-ups. Flare-ups can last many months and may come back at different times throughout your life.

Symptoms of Inflammatory Bowel Disease

What are the symptoms of Crohn’s disease?

The symptoms of Crohn’s disease vary, depending on which part or parts of the gastrointestinal (GI) tract is/are affected. Common symptoms include:

  • Diarrhea
  • Stomach cramps
  • Abdominal pain that comes and goes
  • Blood in your stool
  • Low appetite
  • Unintended weight loss

Other less common symptoms may include fever, joint pain, eye problems, skin problems, and feeling tired (called fatigue). The symptoms of Crohn’s disease may be mild or severe. Symptoms may also come and go. They can start suddenly or gradually.

What are the symptoms of ulcerative colitis?

Symptoms of ulcerative colitis vary. Symptoms depend on how severe your case is and how much of your large intestine is affected. Common symptoms include:

  • Rectal pain or bleeding
  • Frequent, small bowel movements
  • Feeling an urgent need to have a bowel movement
  • Diarrhea
  • Blood in the stool
  • Abdominal cramping and pain
  • A strong feeling that you need to have a bowel movement, but not being able to do so (called tenesmus)
  • Pain on the left side of the abdomen
  • Unintended weight loss
  • Fatigue

In most people who have ulcerative colitis, these symptoms tend to come and go. You may have periods where you have no symptoms, followed by periods where you do have symptoms.

What causes inflammatory bowel disease?

It is not yet known exactly what causes Crohn’s disease and ulcerative colitis. These diseases seem to run in families, which means that genetics play a role. Many researchers believe that inflammatory bowel diseases are caused by a problem with the immune system. Normally, the immune system protects your body from infection. In people who have an inflammatory bowel disease, the immune system mistakes food, healthy bacteria, and other substances for an infection. This causes the immune system to attack the cells of the intestine, which leads to inflammation.

How is inflammatory bowel disease diagnosed?

Your doctor will give you a physical exam and listen to you describe your symptoms. To help diagnose the problem your doctor may order a number of tests, including blood tests and stool samples. Your doctor may also order one or more procedures to help them view your colon. Lower GI endoscopy procedures include colonoscopy and flexible sigmoidoscopy. During these procedures, your doctor uses a narrow, flexible tube to look directly inside your large intestine. Upper GI endoscopy allows a look at your stomach and small intestine for ulcers. For this type of endoscopy, you may swallow a small camera (called capsule endoscopy). If not, your doctor inserts a scope into your GI tract through your mouth.

Your doctor may also order other imaging tests such as X-rays, a CT scan, or an MRI.

Can inflammatory bowel disease be prevented or avoided?

IBD cannot be prevented, but there are lifestyle changes you can make to minimize symptoms. The best thing you can do is to take good care of yourself. It’s important to eat a healthy diet. Depending on your symptoms, your doctor may ask you to reduce the amount of fiber or dairy products in your diet. It also may be necessary to limit or avoid caffeine, alcohol, and carbonated beverages. In addition to eating well, you need to get enough rest and exercise regularly. It’s also important that you learn to manage the stress in your life. When you become overly upset by things that happen at home or at work, your intestinal problems can get worse.

Inflammatory bowel disease treatment

The goal of treatment is to get rid of the inflammation that causes your symptoms. Many types of medicine can help reduce inflammation. Talk to your doctor about anti-inflammatory drugs and drugs that suppress the immune system. Some medicines are needed only during flare-ups. You may need long-term medicines to suppress your immune system. Depending on your symptoms, your doctor may also recommend these medicines and supplements:

  • Antibiotic
  • Anti-diarrheal
  • Laxative
  • Pain reliever
  • Vitamin supplements

In severe cases of inflammatory bowel disease, you may need to go to the hospital for intravenous (IV) fluids or surgery.

During your treatment, you will most likely be treated by a team of doctors. This team may include your family physician, a gastroenterologist (a specialist in stomach and intestinal disorders), and, possibly, a surgeon.

Living with inflammatory bowel disease

If you have inflammatory bowel disease, you are at an increased risk of colon cancer. Talk to your doctor about when to start screening for colon cancer and how often to have screening.

Crohn’s disease and ulcerative colitis keep coming back and their symptoms can be unpredictable. This can cause patients who have these illnesses to become depressed. If you feel depressed, talk with your family doctor. An antidepressant medicine could help you feel better.

How can I get more information?

Ask questions. Read about IBD. Discuss treatments with your doctor. You’ll be able to understand your illness and manage it better. Patient support groups are helpful, especially if you have severe symptoms.

Author: Vanessa Ngan, Staff Writer, 2003.

What is Crohn disease?

Crohn disease is an inflammatory bowel disease that involves inflammation of the small intestine. This can cause pain, fever , constipation, diarrhoea and weight loss. Extraintestinal features are common in Crohn disease and include arthritis , skin problems, inflammation in the eyes or mouth, gallstones and kidney stones. Crohn disease affects about 1 in 300 Europeans and has peak onset in the teens and 20s.

When granulomatous lesions of Crohn disease involve sites other than the gastrointestinal tract, the disease is termed metastatic Crohn disease.

What are the clinical features of cutaneous Crohn disease?

Skin involvement or cutaneous Crohn disease occurs in about 40% of patients with Crohn disease.

Extension of intestinal Crohn disease

Skin tags, swelling ( oedema ), fissures and abscesses around the perineal and perianal region are common in patients with Crohn disease. Painful vulval or scrotal fissures and ulceration may occur. See DermNet NZ’s page on genital Crohn disease.

Metastatic Crohn disease

Metastatic granulomatous cutaneous Crohn disease may present as spots or plaques found on the trunk, arms and legs. Lesions tend to be asymmetrical and involve dermis and or subcutaneous tissue ( panniculitis ). They may be mildly itchy.

Cutaneous reactions to intestinal Crohn disease

In some cases, non-granulomatous skin disorders occur as a reaction to the intestinal disease. These include:

  • Pyoderma gangrenosum
  • Neutrophilic dermatosis / Sweet syndrome , typically with pustules
  • Pyodermatitis-pyostomatitis vegetans, a purulent erosive dermatosis characterised by snail-track ulcers
  • Erythema multiforme
  • Erythema nodosum
  • Acneform eruptions including nodulocystic acne, hidradenitis suppurativa and folliculitis
  • Palisaded neutrophilic and granulomatous dermatitis
  • Necrotizing and granulomatous small vessel vasculitis .

Occasionally, skin lesions may occur before any signs or symptoms of the intestinal disease.

Oral Crohn disease

Oral involvement occurs in 8-9% of Crohn disease and may include:

  • Gingival or mucosal swelling
  • Cobblestoning of the buccal mucosa
  • Aphthous ulcers
  • Mucosal tags
  • Angular cheilitis
  • Granulomatous cheilitis ( persistent lip swelling).
Skin complications of Crohn disease

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

Episcleritis due to Crohn disease, New Zealand Medical Journal. 2006

How to manage eye disorders with crohn's disease

Granulomatous cheilitis due to Crohn disease

How to manage eye disorders with crohn's disease

Oral Crohn disease

Secondary skin eruptions

Crohn disease affecting the gut may lead to malnutrition. Iron deficiency and vitamin deficiencies may present as skin or oral ulceration, persistent infections or pellagra.

Drugs prescribed for Crohn disease may also lead to adverse effects on the skin (drug eruptions).

How is Crohn skin disease diagnosed?

Skin biopsy of the lesion is performed. The histopathological finding of non- caseating granulomas similar to those found in intestinal Crohn disease supports the diagnosis of Crohn skin disease. In patients with no intestinal disease whose skin biopsy shows non-caseating granulomas, a thorough gastrointestinal history and systemic work-up should be performed.

The presence of anti-Saccharomyces cerevesiae (ASCA) antibodies in the blood are very suggestive of Crohn disease, with 60% sensitivity and 90% specificity.

* Granuloma on skin pathology

How to manage eye disorders with crohn's disease

Histology of cutaneous granuloma due to Crohn disease, New Zealand Medical Journal. 2006

Applying for Social Security Disability Benefits with Crohn’s Disease

According to the Centers for Disease Control (CDC), about 1.6 million Americans have inflammatory bowel disorders (IBD). Crohn’s disease is one form of IBD, but the exact number of adults in the U.S. with this type of IBD is uncertain. The Crohn’s and Colitis Foundation of America (CCFA) estimates about 700,000 Americans have Crohn’s disease, and that most Crohn’s patients are diagnosed before the age of 35.

Some people find their symptoms can be controlled effectively with available treatments. Others however continue to have bouts of pronounced symptoms even when following prescribed therapies. Symptoms can include pain, inflammation, fatigue, fever, chronic diarrhea, bowel obstructions, and weight loss, among others, all of which can significantly disrupt your ability to work.

If you are among those for whom Crohn’s is that is uncontrolled by available therapies, then you can qualify for disability benefits from the Social Security Administration (SSA).

Disability programs include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Whether you qualify for one or for both programs, you’ll receive monthly payments that can help you cover your everyday bills and living expenses as well as the costs of ongoing medical care.

The Costs of Crohn’s Disease

In its early stages, Crohn’s may not prevent employment, and some people are able to manage their illness through treatments. For others however, the disease progresses, requiring multiple surgeries, frequent hospital stays, and more and more time away from the job. A loss of earnings is therefore a huge cost associated with Crohn’s. Ongoing medical expenses weigh heavily on many patients as well.

The more frequently Crohn’s symptoms flare up, the higher the medical bills patients face, but even managing the disease can be expensive. Routine colonoscopies are recommended for Crohn’s, and at an average cost of $2,500 to $5,000 for each procedure, just keeping a watchful eye on your illness is a major expense.

Routine treatment for Crohn’s additionally includes frequent doctor visits, blood work, and prescription and over-the-counter medications. Biological drugs, like Remicade, are promising new treatments, but often fall outside the budget range of many patients. The CCFA reports copayments of between $2,000 and $4,000 per month for biological medications.

The CCFA reported the estimated direct costs for people with IDB were $1.84 billion in 2013. Your individual expenses may vary with your symptoms and based on what your insurance covers, but the CCFA puts the average annual expense per IBD patient at about $19,000.

Affording to manage your illness is a huge challenge with Crohn’s, and since stress level can play a major part in disease flare-ups, keeping your financial concerns to a minimum is essential. Social Security Disability benefits can be part of the solution, providing ongoing monthly income that helps offset your expenses and your worries.

How to manage eye disorders with crohn's disease

Medically Qualifying for Benefits for Crohn’s

People suffering from Crohn’s can qualify for benefits by meeting or closely matching the SSA’s Blue Book disability listing for IBD. This listing requires your symptoms are quite advanced, causing bowel tissue degeneration, obstructive scarring in your bowels, and other severe complications. The IBD listing also includes details of how you can qualify for benefits with liver and kidney complications, severe weight loss, and other symptoms.

Understanding the SSA’s requirements can be challenging without your doctor’s help though, because the Blue Book is written primarily for medical professionals. Work closely with your doctor to see if your Crohn’s symptoms and other medical records can satisfy eligibility requirements.

If you’re not able to qualify under the IBD listing, then you may still meet or closely match one of these other listings for digestive system-related disabilities:

  • Section 5.02, for bleeding in your bowels that requires a blood transfusion
  • Section 5.05, for chronic liver complications
  • Section 5.08, for severe weight loss

Qualifying for Benefits without Meeting a Disability Listing

If your symptoms aren’t able to satisfy any disability listing that appears in the Blue Book, you will have a more challenging time qualifying for benefits. This however doesn’t mean that you cannot get approved.

It just means the SSA must take a closer look at your overall limitations by examining your activities of daily living” or ADLs. This is done through a “residual functional capacity” or RFC analysis.

Crohn’s may, for example, cause frequent diarrhea, which means you must be close to a bathroom at all times. This can make it impossible to leave your home to shop for groceries or run errands, let alone go to work. Fatigue and muscle weakness are common with Crohn’s as well and can prevent you from cleaning your house, doing laundry, or any number of other everyday activities. These types of limitations are what the SSA looks for when completing an RFC evaluation.

The SSA also looks at your age, medical records, work history, education level, job experience, and work skills or training. They additionally gather information from you, your doctor, and others about how your symptoms limit your everyday life or ADLs.

Given your limitations discovered through an RFC, the SSA may find you cannot reasonably hold any job. When this is true, you can qualify for disability, even without meeting the requirements of a Blue Book-listed condition.

How to Apply for Disability Benefits with Crohn’s Disease

No matter how you may qualify for benefits, whether through an RFC or a standard, Blue Book listing, your application needs backup documentation or support. This requires giving the SSA access to your medical records, so you’ll need the names and contact information for all your healthcare providers, including your primary doctor but also your IBD specialists and any hospitals or other treatment facilities at which you’ve received attention.

Although the specific tests, treatment records, and other documentation the SSA requires will vary based on your symptoms and your unique situation, a Crohn’s disability application must typically have the following records present in order to be approved:

  • Colonoscopy results, documenting the presence of inflammation, adhesions, or other physical abnormalities or changes in your bowels
  • Blood work and other lab results, showing kidney, liver, and blood count values
  • Treatment records, including medications, surgical procedures, and other symptom management techniques used and their affects
  • Operative notes from any surgical procedures you’ve undergone
  • Physical exam notes from your doctor, documenting symptom type, frequency, and duration

When applying for benefits with Crohn’s, your medical records must also usually include some historical data that shows how your condition has progressed or remained severe over several months. The doctor that coordinates your care for Crohn’s is instrumental in providing this report for the SSA, so be sure to work closely with him or her in applying for benefits.

This process can be quite complicated, but you can get help. You can get a free evaluation regarding your Social Security disability case by filling out this form. Arm yourself with as much information as possible to improve your chances of winning your case.

The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.

  • Abnormalities of the Pupil
  • Atopic Keratoconjunctivitis (AKC)
  • Basal cell carcinoma (BCC) (periocular)
  • Blepharitis (Lid Margin Disease)
  • CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
  • Cellulitis, preseptal and orbital
  • Chalazion (Meibomian cyst)
  • Concretions (conjunctival lithiasis)
  • Conjunctival pigmented lesions
  • Conjunctival scarring
  • Conjunctivitis (Acute Allergic)
  • Conjunctivitis (bacterial)
  • Conjunctivitis (viral, non-herpetic)
  • Conjunctivitis (seasonal & perennial allergic)
  • Conjunctivitis, Chlamydial (adult inclusion conjunctivitis)
  • Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
  • Corneal (or other superficial ocular) foreign body
  • Corneal Transplant Rejection
  • Corneal abrasion
  • Corneal hydrops
  • Dacryocystitis (acute)
  • Dacryocystitis (chronic)
  • Dry Eye (Keratoconjunctivitis Sicca, KCS)
  • Ectropion
  • Endophthalmitis (post-operative) (Exogenous endophthalmitis)
  • Entropion
  • Episcleritis
  • Facial palsy (Bell’s Palsy)
  • Fuchs Endothelial Corneal Dystrophy (FECD)
  • Glaucoma (chronic open angle) (COAG)
  • Herpes Simplex Keratitis (HSK)
  • Herpes Zoster Ophthalmicus (HZO)
  • Hordeolum
  • Keratitis (marginal)
  • Keratitis, CL-associated infiltrative
  • Microbial keratitis (Acanthamoeba sp.)
  • Microbial keratitis (bacterial, fungal)
  • Molluscum contagiosum
  • Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
  • Ocular hypertension (OHT)
  • Ocular rosacea
  • Ophthalmia neonatorum
  • Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
  • Phthiriasis (pediculosis ciliaris)
  • Pigmented fundus lesions
  • Pinguecula
  • Post-operative suture breakage
  • Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
  • Pterygium
  • Recurrent corneal epithelial erosion syndrome
  • Retinal Vein Occlusion
  • Scleritis
  • Steroid-related Ocular Hypertension and Glaucoma
  • Sub-conjunctival haemorrhage
  • Sub-tarsal foreign body (STFB)
  • Trauma (blunt)
  • Trauma (chemical)
  • Trauma (penetrating)
  • Trichiasis
  • Uveitis (anterior)
  • Vernal Keratoconjunctivitis (Spring catarrh)
  • Vitreomacular Traction and Macular Hole
  • How to use the Clinical Management Guidelines

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

How to manage eye disorders with crohn's disease

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Aetiology

Uveitis (anterior)

Anterior uveitis (the most common form of uveitis: 75% of all cases of uveitis). Annual incidence 12 per 100,000 population

  • iritis: inflammation predominantly affects iris
  • iridocyclitis (more common): inflammation predominantly affects iris and anterior part of ciliary body (pars plicata)

The Standardisation of Uveitis Nomenclature (SUN) working group has developed an international standard for classifying uveitis:

  • Onset: sudden or insidious
  • Duration: limited, if it is ≤3 months, or persistent, i.e. >3 months in duration
  • Recurrent: describes repeated episodes of uveitis separated by periods of inactivity without treatment of ≥3 months in duration
  • Chronic: describes persistent uveitis characterized by prompt relapse (in

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Crohn’s Disease Symptoms You Should Never Ignore

Crohn’s disease occurs when immune cells start attacking healthy cells in the gastrointestinal tract, instead of targeting only foreign invaders (like germs). As a result, inflammation in the body can lead to a slew of GI and other symptoms.

Symptoms of Crohn’s disease can range from mild to severe. Most people experience a cycle of active disease followed by periods of remission.

The signs of Crohn’s disease depend on the patient and the part of the GI tract affected, since the inflammation of Crohn’s can strike anywhere from the mouth to the rectum. If a patient is showing the following symptoms, doctors will perform blood tests, colonoscopies, and other procedures to confirm the diagnosis.

Stomach pain

The pain that Crohn’s patients feel tends to be crampy. It often appears in the lower right abdomen but can happen anywhere along the digestive tract. “It depends on where that inflammatory process is happening,” says Nana Bernasko, DNP, gastroenterology expert with the American Gastroenterological Association.

Pain is common in people with Crohn’s disease and can significantly impact quality of life. Over time, Crohn’s disease may cause scarring in the lining of the intestinal tract (called adhesions and strictures) that can lead to painful obstructions. Ongoing inflammation along with ulcers and abscesses in the intestines are common causes of pain.

Sometimes pain is the only sign that the disease is progressing and that a different treatment may be needed.

Nausea

Sometimes, the stomach pain associated with Crohn’s disease is less crampy and sharp, and feels more like nausea. It can also be accompanied by vomiting.

Diarrhea

Digestive trouble might not just mean stomachaches, but diarrhea, too, if the inflammation is affecting the colon. Talk to a doctor if your diarrhea lasts for a couple of weeks and isn’t getting better, says Glenn H. Englander, MD, gastroenterologist in West Palm Beach, Florida.

Sudden need to go to the bathroom

When determining whether diarrhea could be related to Crohn’s disease, it’s not just the consistency of the stool, but the timing. The diarrhea also can come on suddenly, leaving Crohn’s patients dashing for the bathroom.

Constipation

Although not as common as diarrhea, constipation can also be a sign of Crohn’s disease. It can be painful as the stool passes through the system.

Blood in the stool

Crohn’s can lead to tears (fissures) in the lining of the anus, which may cause pain and bleeding, especially during bowel movements, as well as infection. “When people come in with bloody diarrhea and they’re young, you’re worried,” says Dr. Englander. Don’t wait weeks hoping it will go away on its own — head to the doctor.

Weight loss

Even when they aren’t trying to lose weight, people with Crohn’s disease might notice that they’re losing weight. “People avoid eating because it hurts, and they know that when they eat they have to run to the bathroom,” says Dr. Bernasko.

Fatigue

When your body is in a state of inflammation, you might feel exhausted. Unlike when you’re sleepy and simply having trouble focusing, fatigue is when “your whole body feels it,” says Dr. Englander.

Fever

If the disease is severe enough to lead to an abscess, Crohn’s patients could spike a fever in response to the deep-tissue infection. In rarer cases, the inflammation responsible for the rest of the symptoms might directly lead to fever, says Dr. Bernasko.

Mouth sores

The chronic inflammation from Crohn’s doesn’t just affect your insides — some people might notice mouth sores during flare-ups. For people with Crohn’s, the digestive system becomes damaged and can’t properly absorb vitamins and minerals. Those deficiencies paired with inflammation can result in canker sores in the mouth.

Crohn’s Complications

Serious cases of Crohn’s disease can cause other problems both in and outside the digestive tract, including:

  • Inflammation of the skin, eyes and joints
  • Inflammation of the liver or bile ducts
  • Delayed growth or sexual development in children
  • Fistulas (a type of tunnel that can connect the intestines to another part of the bowel, the bladder, vagina, or skin). A fistula can allow fecal matter to pass out of the intestines to other parts of the body, and is thus a serious condition that requires immediate medical attention.
  • Anemia
  • Osteoporosis
  • Gallbladder or liver disease
  • Thickening of intestine walls, which makes it hard for food to pass through during digestion
  • A partly or completely blocked intestine, which needs immediate medical attention

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Crohn’s is a chronic bowel condition that causes inflammation in the intestinal tract, and may cause symptoms of abdominal pain, diarrhea, weight loss, and malnutrition. Crohn’s disease can affect any part of the digestive tract from the mouth to the anus.

The cause of Crohn’s disease is currently not known. Having a family member with an inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) may increase your risk.

  • Diarrhea
  • Abdominal cramps and pain
  • Rectal bleeding
  • Weight loss
  • Fatigue, weakness
  • Nausea
  • Fever
  • Mouth sores
  • Sores, abscesses in the anal area

Diagnosis

Tests to diagnose your condition may include:

  • Blood and/or stool tests
  • X-ray scans (Barium X-rays, CT or MRI scans)
  • Endoscopy procedures that could include:
    • Flexible sigmoidoscopy
    • Colonoscopy
    • Upper endoscopy
    • Capsule endoscopy

Crohn’s Disease Treatment

Dietary Changes

No diet has been proven to reduce inflammation in patients with Crohn’s disease. Your doctor may recommend that you avoid foods that trigger symptoms. As each person may have different triggers, consulting with a dietitian may help.

Medications

Many types of medicines treat Crohn’s disease, including:

  • Anti-inflammatory medicines
  • Immunomodulators
  • Biologic medications

Surgery

Your doctor may recommend surgery to remove the diseased part of your intestine if:

  • Medication fails to improve the disease
  • You have an obstruction or fistula in your intestine

Even after surgery, you will be at high risk for the disease.

Untreated Crohn’s disease may lead to:

  • Fistulas — Abnormal connections between the intestine and other organs or tissues, such as the bladder, vagina or skin
  • Intestinal obstruction
  • Arthritis
  • Eye inflammation
  • Liver disease
  • Kidney stones
  • Gallstones
  • Osteoporosis

Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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    By being open about their health struggles, celebrities have played a part in raising awareness of many chronic conditions.

    How to manage eye disorders with crohn's disease

    A chronic illness is a long-term medical condition that requires treatment and management over a long period of time, usually years. Some of them are well known, like arthritis and diabetes, but there are a whole host of others which have been given more attention in recent years because a celebrity has publicly disclosed having it. Take Lady Gaga, for example, who disclosed a few years back that she has a condition called fibromyalgia.

    While it’s up to any individual what they want to share about their health, there’s no denying that, especially for the lesser-known conditions, having someone talking about it frankly and publicly can raise awareness, lessen stigma and be a supportive force to fans who may be struggling with something. Here are some celebrities who have publicly spoken about their chronic health conditions, from endometriosis to lupus.

    How to manage eye disorders with crohn's disease

    Model and actor Cara Delevingne helped raise awareness of psoriasis – which causes crusty, red patches with silver-type flakes to appear on the skin – whilst walking the red carpet at the 2022 Met Gala.

    For keeping her skin condition on show, the 29-year-old received plenty of praise from fans, who thanked her for being so brave. “Cara Delevingne leaving her psoriasis visible in her Met Gala look is so validating to me,” one person wrote on Twitter, with another fan saying: “Psoriasis is not something to be ashamed of. It’s wonderful how Cara Delevingne used a platform like the Met Gala to raise awareness about this chronic condition.”

    A third fan tweeted: “Seeing @Caradelevingne embrace her psoriasis at the Met Gala literally makes me so emotional. Bad bitches really do have psoriasis.”

    How to manage eye disorders with crohn's disease

    Fibromyalgia is a condition that causes pain all over the body, and someone suffering with it may also experience extreme tiredness, muscle stiffness, trouble concentrating and problems sleeping. According to the NHS, it tends to affect women seven times more than men. There is no cure but symptoms can be relieved through medication, therapy and lifestyle changes.

    Lady Gaga opened up about her experience with the illness for the first time in her 2017 Netflix documentary, Gaga: Five Foot Two. She was also forced to cancel a concert in Brazil because she was taken to hospital with “severe pain”.

    How to manage eye disorders with crohn's disease

    Awareness was definitely raised about psoriasis when it was revealed one of the most photographed women in the world has it.

    After initially freaking out over the the skin condition in an old episode of Keeping up with the Kardashians, Kim Kardashian has since adopted a more serene approach, saying she doesn’t even try to cover it up anymore.

    “I’m always hoping for a cure, of course, but in the meantime, I’m learning to just accept it as part of who I am,” Kim wrote on her website.

    How to manage eye disorders with crohn's disease

    This condition is also known as chronic lymphocytic thyroiditis and is a thyroid disease which can cause difficulty concentrating, hair loss, fatigue and weight gain. Gigi has previously said that the disease actually meant she struggled to put weight on.

    “My metabolism actually changed like crazy this year,” she told Elle in 2016. “I have Hashimoto’s disease. It’s a thyroid disease, and it’s now been two years since taking the medication for it, so for the VS show I didn’t want to lose any more weight,

    Endometriosis is a poorly understood medical condition where the lining of the womb is found in other parts of the body, most often the ovaries.Lena Dunham has been particularly honest about her experience with the condition, which like so many other sufferers, was misdiagnosed for years.

    Speaking to Cosmopolitan UK as part of her March 2020 cover interview, the Girls creator said: “Having endometriosis has had a really interesting effect on my relationship with my body. Pain does not inherently make you feel sexy; pain doesn’t make you feel beautiful, but in another way it’s forced me to really take ownership of my body and express my needs.”

    Lena has undergone a total hysterectomy as a result of complications from endometriosis, which came as a difficult thing to accept, because she “never had any doubt that I wanted to be a mother”. But after riding the waves of this loss, Lena says she’s arrived at a place of acceptance – and even positivity – about how infertility has transformed her approach to dating.”I’m no longer relying on any male partner to make motherhood possible for me,” she shared.

    How to manage eye disorders with crohn's disease

    Sia is renowned for keeping much of her life private, but despite that she has publicly confirmed that she suffers from thyroid condition Graves’ disease. Back in 2010, the singer/songwriter posted on Twitter about her diagnosis, saying: “i’m not crazy! i have graves disease! the shakes, the nerves. THE CRAZY!! goodbye thyroid. i will kill you with radioactivity.”

    Graves’ disease is an autoimmune disorder that causes an overactive thyroid, because your immune system attacks the thyroid and causes it to make more of the hormone than your body needs. The condition can cause shaky hands, a fast and and irregular heartbeat, irritability or nervousness, tiredness, and muscle weakness.

    How to manage eye disorders with crohn's disease

    Star Wars actress Daisy has also publicly shared her struggle with endometriosis and PCOS. Writing about the repercussions it’s had on her life in an Instagram post a few years back, Daisy said: “8 years [after being diagnosed], pain was back (more mild this time!) and my skin was THE WORST. I’ve tried everything: products, antibiotics, more products, more antibiotics) and all that did was left my body in a bit of a mess.

    “Finally found out I have polycystic ovaries and that’s why it’s bad. I can safely say feeling so self conscious has left my confidence in tatters. I hate wearing make up but I currently don’t want to leave the house without it on. HOWEVER PROGRESS IS BEING MADE!

    “My point is, to any of you who are suffering with anything, go to a doctor; pay for a specialist; get your hormones tested, get allergy testing; keep on top of how your body is feeling and don’t worry about sounding like a hypochondriac. From your head to the tips of your toes we only have one body, let us all make sure ours our working in tip top condition, and take help if it’s needed.”