OCULAR SURFACE DISEASE ASSOCIATED WITH ROSACEA IN A YOUNG PATIENT WITH CROHN'S DISEASE ON LONG-TERM ADALIMUMAB THERAPY: A CASE REPORT

To report a case of ocular surface disease, specifically corneal pannus, associated with rosacea in a young male with Crohn’s disease on long-term adalimumab therapy, and to explore the potential link between TNF-alpha inhibitors and ocular manifestations.

A tertiary ophthalmology clinic.

A 19-year-old male with Crohn’s disease presented with a 4-month history of worsening blurred vision, light sensitivity, and bilateral corneal pannus while on long-term adalimumab therapy. The patient had been receiving 40 mg of adalimumab weekly for over three years. Dermatologic findings included facial erythema and pustules suggestive of rosacea. Treatment with doxycycline, cyclosporine, topical corticosteroids, and autologous serum eye drops was initiated, and adalimumab was discontinued and switched to vedolizumab after consultation with the gastroenterologists.

At the 4-month follow-up, the patient reported significant improvement in visual symptoms and corneal pannus regression. Best-corrected visual acuity improved from 20/70 to 20/50 in the right eye and from 20/100 to 20/30 in the left eye. Dermatologic symptoms of rosacea also improved with systemic and topical therapy. The patient experienced no flare-ups of Crohn’s disease after transitioning from adalimumab to vedolizumab

This case highlights a possible connection between long-term adalimumab therapy and ocular surface disease in patients with Crohn’s disease, potentially mediated by rosacea. Transitioning to vedolizumab led to marked ocular and dermatologic improvement, underscoring the need to consider alternative therapies when dermatologic or ocular complications arise in patients on TNF-alpha inhibitors.