The GI-Eye Connection

编者按：“让你的博士”这个故事是HealthCentral一系列新的叫的一部分，这是向谁已经得到了他们的情况下的基本知识，并希望他们的专业技术人员为目标。谁是准备去亲？

当你第一次诊断为像克罗恩病（CD）一种慢性疾病，你的重点是处理手头的（直译）紧急症状。过了一会儿，大多数人发现他们的新标准有了它，一个新的节奏。但是，即使你的CD控制良好，其关键是要留在你的顶级护理，尤其是当它涉及到眼睛的健康。

Crohn’s disease may be a digestive disorder, but at least 1 in 10 people experience issues with their eyes, which range from mild pain and irritation to severe dryness and (less commonly) vision loss. In fact, when researchers gave inflammatory bowel disease (IBD) patients an eye exam, they found previously undiagnosed conditions in a whopping 92% of them, according to a small study published in the欧洲胃肠病学与肝病学。Sumitra Khandelwal，医学博士，医学院在休斯敦贝勒医学院眼科副教授说，尽管发现这样的，有任何炎性肠病，包括克罗恩病和溃疡性结肠炎没有常规筛查指南或推荐的眼睛检查。

While we don’t know exactly why Crohn's sometimes causes complications in the eyes, the current thinking is this: The inflammation in your digestive tract is your body’s reaction to gastrointestinal antigens (toxins or other foreign substances that initiate an immune response in the body). Some of the antigens in your eyes are like those in your GI system. Once these antigens are recognized, the body attacks them, too, creating another type of autoimmune reaction, explains Benjamin Bert, M.D., ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.

Alternatively, some researchers believe certain immune complexes (a.k.a. molecules that form when an antigen and antibody bind together) from the gut could be absorbed and travel through the bloodstream, where they're then deposited in the blood vessels of the eyes, causing inflammation.

不管怎样,我们知道任何眼部并发症from a systemic inflammatory disorder like Crohn’s can damage your vision and the structure of your eye if not identified and treated swiftly. And while every patient who's been living with IBD should be aware of these potential problems—and see your optometrist and/or ophthalmologist regularly—it's particularly important for women, anyone diagnosed with Crohn's before age 40, and those with a family history of Crohn's or UC, says Dr. Bert. These groups tend to be a higher risk for eye problems.

我们的导游最常见的Crohn's相关的眼部问题，能帮助你保持领先一步。

Episcleritis

What it is:The condition causes inflammation in the layer between the conjunctiva (that’s the clear layer on top of the white of the eye) and the sclera (the white tissue of the eye). Among all the eye complications, episcleritis is tied to Crohn’s inflammation the most, according to a study analysis in theWorld Journal of Gastroenterology。That means if your inflammation levels are high, your eyes are going to feel it. But getting the underlying IBD under control will help improve the symptoms, Dr. Bert adds.

症状和可能出现的并发症：Episcleritis is a benign condition and most symptoms are limited to mild pain and irritation of the eye. It doesn't cause permanent damage.

How it’s treated:Most of the time, docs will treat episcleritis with just observation as they continue to treat the systemic inflammation of the disease, Dr. Bert says. In some cases, lubricating eye drops can help soothe the discomfort. Corticosteroid eye drops may also be prescribed for short-term use but should never be used long term because of the potential for complications like cataracts or glaucoma.

干眼病

What it is:Dry eye disease is three times higher in people with inflammatory bowel disease compared to people without, according to a study published inEye & Contact Lens。But folks with Crohn's specifically are the most likely to develop dry eye disease compared to those with other types of digestive inflammation, according to Hungarian research. Here’s why:

Dry eye disease typically stems from the malabsorption of nutrients, which comes with the CD, Dr. Bert explains. People with Crohn's have a harder time absorbing water, vitamins, and minerals. As a result, they have a harder time producing enough liquid for tears, and the tears they do produce may evaporate more quickly, creating the symptoms of dry eye.

症状和可能出现的并发症：The most common symptoms are dryness (of course), blurry视力，疼痛和发痒的感觉。如果眼睛干涩转为慢性或严重的，他们可以影响新血管生长或瘢痕您的眼球表面，两者均可导致视力低下。

How it’s treated:治疗克罗恩的潜在的炎症和日常使用人工泪液是治疗干眼病最常见的方式，但许多文档还建议将水分超过眼睛加湿器和温压环境。你的医生也可能建议眼药水如皮质类固醇虚弱或环孢素，以减轻炎症和增加泪液产生。

角膜病

What it is:角膜病是克罗恩通常极端干眼病发展的一个难得的表现。随着水分少涂眼中，这可以创造一个眼睛就会变得这么干的，它创造了自己的类型炎症的情况下，伯特博士解释说。

症状和可能出现的并发症：Surprisingly, keratopathy doesn't create any pain or vision issues, so it's super hard to diagnose. An ophthalmologist must be looking for it specifically, using a special slit lamp to spot white deposits at the edge of the cornea. Doctors don't know what the dots are exactly—there are no known biopsies of the lesions, reports a paper inThe Scientific World Journal。But we do know that since they typically occur at the corners of your cornea, they often spare your central vision.

How it’s treated:总体而言，角膜病变通常不会造成严重的损害，往往解决自身（即，最好的治疗方法是底层克罗恩全身免疫抑制剂）。然而，如果炎症，因此角膜病变，没有得到及时治疗，它可以前进，成为麻烦的一点，它可能需要与钙结合眼药水或（最后）办公室内的程序那里的医生擦伤进行处理沉积物离角膜的表面上。

葡萄膜炎

What it is:葡萄膜炎是眼球内炎症本身和is the most dangerous of all eye complications because it progresses quickly and can lead to permanent vision loss. “Typically, the inside of the eye is protected by a blood-aqueous barrier, which prevents blood cells from entering the fluid inside of the eye. With the inflammation created by the autoimmune condition, this barrier breaks down and components of the blood can enter the fluid within the eye,” Dr. Bert explains. That's bad news because it leads to inflammation and swelling that destroys eye tissue. It's a more common ocular complication, but it mostly manifests in people with severe Crohn's disease, according to a 2019 meta-analysis in在消化内科治疗进展。

症状和可能出现的并发症：The breakdown of the blood-aqueous barrier and, therefore, the release of blood into the eye creates symptoms like redness, light sensitivity, pain, blurry vision, and floaters, Dr. Khandelwal adds. The real risk comes with complications though: Inflammation in the eye can lead to tiny lesions, which in turn cause vision-impairing scar tissue to develop. It can create elevated eye pressure, which can lead to cataract formation. Or it can contribute to retinal swelling called macular edema, or even glaucoma (a break down of the eye's optic nerve), both of which can cause irreversible loss of vision, Dr. Bert adds.

How it’s treated:Unlike the other conditions, uveitis doesn’t necessarily follow the activity level of Crohn's disease itself. Instead of focusing on the underlying inflammation to treat it, the condition typically requires topical steroids, then systemic immunomodulators (meds that help regulate your immune system, like methotrexate and azathioprine) if it becomes chronic, Dr. Bert explains.

Interestingly, emerging research suggests dysfunction in your gut microbiome may come into play. A study by researchers in India, for example, found that people with uveitis were more likely to have dysbiosis (a microbial imbalance in the body) compared to people without the condition. Early stage research by the NIH found that mice who were genetically engineered to eventually develop uveitis had higher levels of activated T-cells (your immune cells that penetrate that blood-aqueous barrier and cause the problems) specifically in the gut.

当小鼠给予吃药来清除它们的肠道细菌，包括活化的T细胞，它们没有发展葡萄膜炎，直到很久以后和严重程度不高。因此，研究人员开始考虑粪便移植（是的，那是在一丸船尾）的人与葡萄膜炎，以帮助复位患者的微生物。

Give the Eye Doc a Full Picture

虽然在眼睛最并发症是可以治疗的，研究表明，症状可能很容易就会被您的文档忽视，所以它要告诉你的验光师，你有克罗恩病是超级重要。

Outside of the complications mentioned here, inflammatory bowel disease can cause other, peripheral issues: For example, a recent study in眼科研讨会发现那些以IBD（无论是Crohn's要么betway.apk ）具有更薄的角膜相比那些没有炎性疾病。其他的研究表明，具有薄角膜可导致“人为压低”读数时，医生测量你的眼睛压力。这可能导致可能错过了青光眼的诊断，及时治疗时，根据青光眼研究基金会，可以永久损害视力的条件。

另一件事要记住：你可以有眼部并发症，即使它出现在克罗恩在控制之下，伯特博士补充道。即使血液中的炎症水平足够低，他们不会表现为典型的克罗恩病的症状，但是也有一些关系到治疗的副作用一些眼部疾病。例如，长期使用糖皮质激素（通常用于炎症），与越来越白内障和特定类型的角膜病变的风险较高。

In some cases, if you’ve developed ocular complications while wrangling your Crohn’s, those issues tend to stick around and need to be treated once the inflammation is controlled, he explains. “Any symptoms of redness, pain, light sensitivity or decreased vision in a patient who has Crohn’s deserves to be worked up and examined,” says Dr. Bert.