Many eye conditions are associated with ulcerative colitis (UC). The inflammation that targets the colon and rectum can also affect the eyes.

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects the large intestine and rectum. Sometimes, other parts of the body are affected by the inflammation, including the eyes.

Treatment to reduce overall inflammation often helps to manage symptoms in the gut and the eyes. However, you might sometimes need different care for your eyes.

Here are some eye conditions that are linked with UC.

You may be more likely to develop an inflammatory eye condition when you have UC. The inflammation of UC doesn’t just stay in the digestive tract. It may cause problems in other parts of your body.

Eye conditions are more likely to show up during a flare of UC but may develop even in remission.

One study from Greece showed that about 1 in 3 participants with IBD also had symptoms in another part of their body. One older study from 2015 found that 4% of participants with IBD also had an eye condition.

Eye conditions may occur during a flare of UC when there is more inflammation in the body. It’s also possible that eye problems may develop during remission or even before symptoms of IBD start.

UC is an inflammatory autoimmune condition. It develops when the immune system releases inflammatory proteins that cause damage to the large intestine and rectum. The inflammation that causes symptoms of UC can also affect your eyes.

Here are some eye conditions that are associated with UC.

Episcleritis

Episcleritis is inflammation in a part of your eye called the episclera. The episclera is the clear layer on top of the white of your eye.

Episcleritis is most likely to develop when you’re experiencing a flare in your UC. It’s one of the most common eye conditions in people with IBD.

Episcleritis makes your eyes red and can feel sore and irritated. However, it does not cause damage to your eye or changes in your vision.

In most cases, episcleritis will improve as the inflammation in the rest of your body goes down. It typically resolves on its own but can last up to 21 days.

You can talk with your eye care professional about drops to help relieve the symptoms of episcleritis.

Scleritis

This is an inflammatory condition that looks similar to episcleritis, but it’s more serious.

Scleritis affects the white part of your eye, known as the sclera. It causes redness and irritation. Scleritis can be very painful and will cause changes in your vision.

It’s fairly rare, with less than 1% of people with IBD developing this condition. It can occur during a flare or remission. People with other inflammatory conditions, such as lupus or rheumatoid arthritis, also have an increased risk of developing scleritis.

It’s treated with steroids or other medications that quickly lower inflammation.

Uveitis

The uvea is the middle layer of the eye, under the sclera (white of the eye). The uvea includes a few parts of the eye, including the iris. The uvea adjusts to let in the right amount of light and help to focus. When it gets inflamed, it’s known as uveitis.

Uveitis causes blurred vision and redness and can be painful. It typically gets better as the inflammation in your body goes down. It can also develop separately from a flare of UC.

Treating uveitis is important to prevent complications such as glaucoma. Steroid eye drops or treatments that lower the immune response can treat uveitis.

There’s a possible association between the use of anti-TNF-alpha inhibitors, such as etanercept, infliximab, and adalimumab, and a greater risk of developing uveitis. The reason behind this is unclear because anti-TNF-alpha inhibitors are medications used to manage UC and prevent eye inflammation.

It’s always important to discuss the benefits and risks of treatments with your healthcare professional.

Cataracts

Cataracts are cloudy spots that can develop on the lens of your eye. The lens is behind your iris.

Normally, the lens is clear and helps you focus on an image. But cataracts can develop when the proteins that make up the lens start to break down. These cloudy spots can create spots or blurry areas in your vision.

Corticosteroids are medications to lower inflammation throughout the body. They may be used to help induce remission and manage symptoms of UC. Long-term corticosteroid use has been linked to an increased risk of developing cataracts.

Cataracts develop slowly over time. Surgery is the only way to remove cataracts but it may be years before you need surgery.

Dry eye disease

Every time you blink, a thin tear film coats the eye. This protects the surface of your eye and helps to keep it clean.

When you don’t have enough tears or your tears don’t contain the normal balance of oil, water, and mucus, symptoms of dry eye disease can develop. Your eyes might be red and feel gritty and irritated.

Researchers have found that people with IBD have higher rates of dry eye disease than the general population. Inflammation may damage the glands involved in tear production, leading to dry eye disease.

Artificial tear drops can be helpful in treating dry eye disease. You can also protect your eyes by avoiding irritants like smoke or dry air.

If dry eye disease is left untreated, it may cause damage to the cornea due to a lack of protection from healthy tears.

According to a 2023 study conducted in Taiwan, higher rates of corneal surface damage were seen in people with IBD compared to a control group.

Optic neuritis

The optic nerve is located at the back of the eye. It’s how the eye and the brain communicate to process the images you see. Optic neuritis develops when the optic nerve gets inflamed.

It’s a pretty rare condition, but when you have UC or other autoimmune conditions, you’re at a higher risk of developing it. Optic neuritis can affect your vision, so it’s important to be aware of this possible complication.

Optic neuritis causes pain, especially when you move your eye. Colors may look faded, and vision can become blurry.

Optic neuritis may resolve as the inflammation in your body goes down. Your eye care professional might recommend steroid drops or pain medication in the meantime.

Sometimes, eye conditions can be prevented, but not always. If you do develop an eye condition, it’s not your fault. UC can be a challenging condition to live with, and it’s not always possible to manage every aspect of it.

It can take time to find the right treatment that lowers the inflammation. Managing UC can help to prevent eye-related issues.

Early detection is always better. If you notice any changes in your vision or how your eyes look or feel, talk with your healthcare professional.

Since some eye conditions are associated with UC, it’s a good idea to have an optometrist or ophthalmologist as part of your healthcare team. An eye health professional can support you with any changes in your eye health.

It’s recommended that you have regular eye exams so any changes can be caught early. If you notice any changes in your eyes, talk with your healthcare professional.

You can also let your primary care doctor or gastroenterologist know about any changes in your eyes. It can be a sign of ongoing inflammation in your body even if other symptoms have improved.

UC is associated with several eye conditions. The inflammation that causes UC can also target parts of your eye. Many eye conditions will improve as your UC symptoms settle.

If you notice any changes in your eye health, let someone on your healthcare team know. It’s wise to get things checked early.