Bilateral corneal pannus in Crohn's disease and assumed adalimumab-associated ocular surface disease

Purpose

Anti-tumor necrosis factor (TNF)-alpha inhibitors are commonly used in the treatment of inflammatory bowel disease (IBD). Despite a beneficial risk-profile, dermatologic and ocular complications may particularly develop at higher doses. Here, we report a case of bilateral corneal pannus in a patient with Crohn's disease, which occurred following a prolonged adalimumab overdose.

Observations

A 19-year-old male with Crohn's disease presented with progressive bilateral blurred vision, conjunctival injection, and light sensitivity. Clinical examination, including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, and funduscopy, revealed severe bilateral corneal pannus with vascularization extending superior to the limbus. The patient had been mistakenly administering adalimumab (40 mg) weekly instead of biweekly for over two years. Given the suspected medication-induced ocular surface disease, adalimumab was discontinued, and the α4β7 integrin antagonist vedolizumab was initiated. Adjunctive topical and systemic therapy was also implemented. At the 2-month follow-up, corneal pannus regressed, visual acuity improved, and ocular symptoms significantly decreased. Further improvement was observed at the 4-month follow-up.

Conclusions and importance

Bilateral corneal pannus can be a rare ocular complication of long-term TNF-alpha inhibitor therapy. Particularly in young IBD patients, dermatologic and ocular complications should be considered. In severe cases, modification of the immunosuppressive agent along with targeted therapy should be implemented to prevent vision loss.