Blepharitis and Crohn's Disease: Understanding the Overlap Between Eye and Gut Health

Blepharitis and Crohn's disease may seem like unrelated conditions—one affecting the eyes, the other the digestive tract- but research and patient experiences have highlighted a surprising link between the two. While blepharitis is commonly known as a chronic inflammation of the eyelid margins, Crohn’s disease is a type of inflammatory bowel disease (IBD) that primarily impacts the gastrointestinal system. However, ophthalmic manifestations of Crohn’s disease are well-documented, and eye problems like blepharitis are among the more frequently reported extraintestinal complications.

If you're living with Crohn’s disease and have recently noticed red, itchy, crusty eyelids or other discomfort around the eyes, you’re not alone. Understanding this connection can help you seek proper treatment early and prevent complications from escalating.

How Are Blepharitis and Crohn’s Disease Connected?

Blepharitis and Crohn’s disease are both inflammatory conditions. While the inflammation in Crohn’s disease primarily targets the gastrointestinal tract, it can also impact the skin, joints, and eyes. The immune dysregulation seen in Crohn’s may lead to inflammatory conditions elsewhere in the body, including chronic eyelid inflammation like blepharitis.

A particularly relevant connection is the body’s autoimmune response. In Crohn's disease, the immune system mistakenly attacks healthy tissues in the digestive system. This immune dysregulation may also trigger inflammation in the eyelids, leading to ocular surface disease symptoms like:

• Itchy, red, or swollen eyelids
  
  
• Crusty eyelashes upon waking
  
  
• A burning or gritty sensation in the eyes
  
  
• Blurred vision or increased light sensitivity
  
  

These symptoms align closely with classic signs of blepharitis, suggesting that individuals with Crohn’s disease may have a predisposition to develop ocular complications.

Paradoxical Inflammatory Blepharitis in a Patient with Crohn’s Disease

A growing body of clinical evidence supports the link between Crohn’s and eye-related issues. One notable finding is the occurrence of paradoxical inflammatory blepharitis in a patient with Crohn’s disease, where treatments used to suppress Crohn’s symptoms may inadvertently trigger eye issues.

For example, tumor necrosis factor (TNF) inhibitors like infliximab or adalimumab, commonly prescribed for Crohn’s, can sometimes cause blepharitis and ectropion as side effects. This is an important consideration when managing patients on biologics, as they may need regular eye examinations to detect early signs of inflammation.

Crohn disease can complicate eye health in unexpected ways, and awareness among patients and healthcare providers is essential for integrated care.

Crohn’s Disease and Eye Problems: What to Know

In addition to blepharitis, Crohn’s can be associated with a range of eye problems such as:

• Episcleritis: Inflammation of the thin layer covering the white of the eye
  
  
• Uveitis: Inflammation of the uvea, which can cause pain, redness, and blurred vision
  
  
• Keratoconjunctivitis sicca: Also known as dry eye syndrome
  
  

While not all Crohn’s patients will experience these issues, those who do may notice symptoms worsen during a flare-up. This points to a shared inflammatory pathway between the gut and ocular surfaces. It’s critical for patients and providers to be proactive and address eye symptoms early to prevent long-term damage.

Why Blepharitis Is Often Missed in Crohn’s Patients

Despite the correlation, blepharitis often goes undiagnosed or under-treated in people with Crohn’s disease. That’s because its symptoms—dryness, redness, itching—may be mistaken for allergies, conjunctivitis, or general eye fatigue. Without proper evaluation by a dry eye specialist, ocular manifestations of Crohn’s can be mismanaged or ignored.

Additionally, patients may not realize that eyelid inflammation is tied to their systemic disease, particularly if they’re focused on managing GI symptoms. Raising awareness about this link is vital to ensuring comprehensive care.

Managing Blepharitis with Crohn’s Disease: A Collaborative Approach

The key to managing blepharitis and Crohn’s disease lies in collaborative care between gastroenterologists and eye care professionals. A multi-disciplinary treatment plan ensures that both the gut and eyes are addressed simultaneously. Here are a few effective approaches:

1. Eyelid Hygiene and In-Office Treatments

For most cases of blepharitis, maintaining proper eyelid hygiene is crucial. Warm compresses, lid scrubs, and gentle cleansers can help reduce crust and inflammation. For more severe or chronic cases, in-office procedures like BlephEx or meibomian gland expression may be recommended.

2. Anti-Inflammatory Therapies

Mild steroid eye drops or topical antibiotics (like azithromycin gel) can be prescribed to address ocular surface inflammation. However, care must be taken when combining these with Crohn’s medications, especially TNF-α inhibitors, as interactions or paradoxical effects may arise.

3. Dietary and Lifestyle Adjustments

Some patients find relief through anti-inflammatory diets, omega-3 supplementation, and reduced screen time. These holistic strategies may improve symptoms of both Crohn’s disease and blepharitis.

4. Regular Monitoring

Ongoing eye exams are vital for patients with IBD to monitor for any ophthalmic manifestations. Optometrists and ophthalmologists who are familiar with systemic conditions can provide more effective treatment and early intervention.

The Emotional and Practical Impact

Living with both blepharitis and Crohn’s disease can be taxing—physically and emotionally. Patients often deal with overlapping symptoms, side effects from medications, and lifestyle limitations. Blurry vision or eye discomfort can add a frustrating layer to an already complex health journey.

Acknowledging this burden and promoting integrated, compassionate care helps improve outcomes and overall quality of life for patients managing these chronic conditions.

When to See a Specialist

If you’ve been diagnosed with Crohn’s disease and are experiencing symptoms such as red, itchy, or crusty eyelids, don’t dismiss them as minor irritations. These may be signs of blepharitis, a condition that can be effectively treated with proper care. Early diagnosis and treatment can prevent complications like corneal damage, vision disturbances, or chronic dry eye.

We recommend scheduling a consultation with a dedicated dry eye specialist who understands the complex interactions between autoimmune diseases and eye health.

Find Relief from Blepharitis Linked to Crohn’s Disease

At Centers for Dry Eye, our team specializes in diagnosing and managing complex ocular surface conditions, including those that stem from systemic inflammatory diseases like Crohn’s. Whether you're dealing with ocular manifestations of Crohn's disease or looking for lasting relief from chronic eyelid inflammation, we’re here to help.

Take the first step toward healthier eyes and greater comfort. Explore our blepharitis treatment options and book your consultation today.