Crohn's disease is an idiopathic inflammatory disease of the upper and lower intestinal tract characterized by transmural inflammatory ulcers of the digestive system featuring noncaseating granulomas. Extraintestinal manifestations are present in 25–35% of patient with Crohn's disease. Ocular manifestations occur in less than 10% of cases and include episcleritis, scleritis, uveitis, retinal vasculitis, optic neuropathy, and idiopathic orbital inflammatory disease.1, 2, 3
We report the case of a 10-year-old female who presented with bilateral dacroadenitis as one of the initial manifestations of previously unrecognized Crohn's disease.
A previously healthy 10-year-old Caucasian female was referred to the eye department with a 1-week history of bilateral upper eyelid swelling associated with moderate discomfort. The patient had a 3-weeks history of fever, abdominal pain, diarrhoea, aphthous oral lesions, and arthritis.
Examination disclosed uncorrected visual acuity of 20/20 OU, and bilateral upper eye lid swelling, more prominent temporally, conferring an ‘S’-shaped contour to the margin (Figure 1). The upper eyelids were tender, and erythematous with a light purple hue. Bilateral mild lacrimal gland swelling was present. There was no evidence of proptosis or ocular motility abnormalities. Examination of the anterior segment, retina, and optic nerve was unremarkable. A diagnosis of bilateral dacroadenitis was made.
Laboratory investigation revealed leukocytosis, anaemia, and an ESR of 70 mm/h. Autoantibody screen, and serology for Epstein–Barr virus were negative. Colonoscopy disclosed multiple deep ulcers throughout the colon. Histopathologic examination of biopsied specimen demonstrated granulomatous inflammation involving the terminal ileum and colon, confirming the diagnosis of Crohn's disease.
The patient was treated with intravenous methyl prednisolone (1.6 mg/kg/day) for 3 days followed by oral therapy. Her symptoms responded promptly to the treatment with complete resolution of dacroadenitis within 2 weeks.