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Eye disease linked to gut

Certain eye pathologies can show links to rheumatoid and gastro diseases

Priscilla Lynch

Posted: Friday, December 1, 2017

Ophthalmologists need to be more aware of the links between certain eye pathologies and rheumatoid and gastroenterological conditions, and refer these patients to the relevant specialties, the Irish College of Ophthalmologists 2017 Annual Conference heard.

Recurrent uveitis can indicate that a patient has an underlying autoimmune disease such as ankylosing spondylitis, while gut-related symptoms in eye patients can be indicative of inflammatory bowel disease (IBD), cautioned Doug Veale MD, Consultant Rheumatologist, St Vincent’s University Hospital, Dublin, who discussed managing inflammatory disease with biologic medications.

He highlighted the link between uveitis and spondyloarthropathies (SpA) – anterior uveitis is the most common extra-articular manifestation of SpA. Prof Veale promoted the usefulness of DUET (Dublin Uveitis Evaluation Tool), an algorithm developed to assist earlier diagnosis of SpA by ophthalmologists in acute anterior uveitis.

“It [DUET] is very simple and focuses on the presence or absence of inflammatory back pain. So, if patients have back pain that is worse in the morning time and gets better with exercise, that is the key,” Prof Veale told EuroTimes.

Discussing the various biologics, he concluded that monoclonal antibodies seem to have a higher level of efficacy than the fusion proteins in treating uveitis and SpA, with promising new agents in the pipeline.
Also speaking during the conference was Richard Farrell MD, Consultant Gastroenterologist, Connolly Hospital, Dublin, on the diagnosis and management of gut inflammation in ophthalmology patients.

He recommended that doctors ask patients about symptoms outside their own disease areas, e.g. do eye patients have gut symptoms, etc. Suspect IBD symptoms in ophthalmology patients can include chronic diarrhoea, abdominal cramps, rectal bleeding, weight loss, anaemia and raised inflammatory markers (WBC, ESR, CRP). However, the majority of these patients will have IBS, haemorrhoids and gastroenteritis rather than underlying IBD, he explained.

Ocular manifestations are more common in female gastroenterology patients, those with colitis and patients with other extra-intestinal manifestations, said Prof Farrell. Episcleritis, scleritis and anterior uveitis are the most common ocular manifestations of underlying IBD, and treatment of the underlying IBD can cure the eye pathology, he noted, adding that steroids and anti-TNF therapies are effective for chronic scleritis and uveitis.

Prof Farrell also highlighted that IBD therapy can cause ocular pathology, including posterior subcapsular cataracts, glaucoma and opportunistic ophthalmic infections induced by systemic or topical steroids, optic neuropathy, nystagmus, ophthalmoplegia caused by cyclosporine and anti-TNF therapies, while methotrexate can build up in tears and cause conjunctival/corneal irritation.

Richard Farrell: rfarrell@rcsi.ie
Douglas Veale: douglas.veale@ucd.ie