Scleritis Occurring During Crohn's Disease: A Case Report

Scleritis is an ocular surface disease that’s associated in one out of two cases with a systemic pathology, its early diagnosis improves the therapeutic response and therefore the prognosis. Crohn's disease is a chronic inflammatory disease of the entire digestive tract, evolving through episodes of relapses and remissions. Ocular involvement in Crohn's disease is rare, polymorphic and can affect all layers of the eye. We will approach in this work the case of an anterior nodular scleritis occurring during Crohn's disease.

Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco

A 15-year-old patient, with a history of Crohn's disease diagnosed 2 years ago, currently in remission on salazo-sulfapyridine 3g per day, presented with a first episode of red left eye associated with severe periorbital pain associated with lacrimation and photophobia for 2 days in whom the ophthalmological examination found: in the left eye, visual acuity at 10/10, conjunctival hyperemia with scleral redness and presence at the nasal level of an immobile nodule compared at a deep level. The rest of the examination of this eye as well as the other eye is normal. 

The use of a drop of Neosynephrine did not allow a complete disappearance of the redness as in episcleritis. These elements conclude to a non-necrotizing nodular anterior scleritis. Treatment with steroids at a rate of 1.5 mg/kg/d was initiated with good clinical evolution by reducing redness and pain. A progressive degression was made.

The occurrence of scleritis in Crohn's disease is extremely rare. In the literature, inflammatory bowel disease represents only 2% of all scleritis etiologies.