• Anti-TNF
• Biologics
• Inflammatory eye disease
• Ocular adverse event
• Optic neuritis
• Uveitis

• National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology

This paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions.

Rheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions.

PubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs.

A total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review.

The goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.

• immunology
• pharmacology
• treatment medical

Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

• Inflammatory bowel disease
• Crohn’s disease
• Ulcerative colitis
• Ocular complications
• Eye manifestations

• Gastroenterologists/organization & administration
• Immunosuppressive Agents/therapeutic use
• Inflammatory Bowel Diseases/complications
• Inflammatory Bowel Diseases/drug therapy
• Inflammatory Bowel Diseases/epidemiology
• Intersectoral Collaboration
• Ophthalmologists/organization & administration
• Patient Care Team/organization & administration
• Prevalence
• Recurrence
• Scleritis/drug therapy
• Scleritis/epidemiology
• Scleritis/etiology
• Uveitis/drug therapy
• Uveitis/epidemiology
• Uveitis/etiology

• Adalimumab
• Angiogenesis Inhibitors/therapeutic use
• Animals
• Antibodies, Monoclonal/therapeutic use
• Antibodies, Monoclonal, Humanized/therapeutic use
• Antibodies, Monoclonal, Murine-Derived/therapeutic use
• Aptamers, Nucleotide/therapeutic use
• Bevacizumab
• Biomarkers/metabolism
• Diabetic Retinopathy/pathology
• Etanercept
• Eye Proteins/metabolism
• Humans
• Immunoglobulin G/therapeutic use
• Infliximab
• Interleukin-12/metabolism
• Mice
• Neovascularization, Pathologic
• Nerve Growth Factors/metabolism
• Quality of Life
• Ranibizumab
• Receptors, Tumor Necrosis Factor/therapeutic use
• Rituximab
• Serpins/metabolism
• Somatomedins/metabolism
• Transforming Growth Factor beta/metabolism
• Tumor Necrosis Factor-alpha/antagonists & inhibitors
• Tumor Necrosis Factor-alpha/metabolism
• Vascular Endothelial Growth Factor A/antagonists & inhibitors
• Vascular Endothelial Growth Factor A/metabolism