Skip to main content

Ocular manifestations in celiac disease: an overview

A Correction to this article was published on 02 April 2020

This article has been updated



To review and highlight the ocular manifestations associated with celiac disease (CD) and presentation of their pathogenetic mechanisms.


A thorough review of the literature was performed using PubMed to identify articles about serrated polyposis syndrome. The search was performed using the search string: (“celiac disease” OR “coeliac disease”) AND (“ocular manifestations” OR “eye” OR “orbitopathy” OR “uveitis” OR “neuro-ophthalmic manifestations”). Only articles in English were reviewed.


Several ocular symptoms and disorders have been associated with CD and are a result of defective intestinal absorption and immunological mechanisms. These include nyctalopia, dry eye, cataract, thyroid-associated orbitopathy, uveitis, central retinal vein occlusion and neuro-ophthalmic manifestations. In addition, CD-related ocular disease may represent the first manifestation of CD.


CD may hold accountable for the development of ocular diseases of obscure etiology.

This is a preview of subscription content, access via your institution.

Change history

  • 02 April 2020

    In the original publication, first line of <Emphasis Type="Italic">methods</Emphasis> under the Abstract section was published incorrectly.


  1. 1.

    Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE (2012) The prevalence of celiac disease in the United States. Am J Gastroenterol 107(10):1538–1544 (quiz 7, 45)

    PubMed  Google Scholar 

  2. 2.

    Singh P, Arora S, Singh A, Strand TA, Makharia GK (2016) Prevalence of celiac disease in Asia: a systematic review and meta-analysis. J Gastroenterol Hepatol 31(6):1095–1101

    PubMed  Google Scholar 

  3. 3.

    Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA, American College of G (2013) ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108(5):656–676 (quiz 77)

    CAS  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Laurikka P, Nurminen S, Kivela L, Kurppa K (2018) Extraintestinal manifestations of celiac disease: early detection for better long-term outcomes. Nutrients 10(8):1015

    PubMed Central  Google Scholar 

  5. 5.

    Martins TG, Costa AL, Oyamada MK, Schor P, Sipahi AM (2016) Ophthalmologic manifestations of celiac disease. Int J Ophthalmol 9(1):159–162

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Karatepe Hashas AS, Altunel O, Sevinc E, Duru N, Alabay B, Torun YA (2017) The eyes of children with celiac disease. J AAPOS 21(1):48–51

    PubMed  Google Scholar 

  7. 7.

    Uzel MM, Citirik M, Kekilli M, Cicek P (2017) Local ocular surface parameters in patients with systemic celiac disease. Eye 31(7):1093–1098

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Tokgoz Y, Terlemez S, Karul A (2018) Fat soluble vitamin levels in children with newly diagnosed celiac disease, a case control study. BMC Pediatr 18(1):130

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Erdem T, Ferat C, Nurdan YA, Halime E, Muhammed Selcuk S, Hamza K et al (2015) Vitamin and mineral deficiency in children newly diagnosed with celiac disease. Turk J Med Sci 45(4):833–836

    PubMed  Google Scholar 

  10. 10.

    Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA (2013) Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients 5(10):3975–3992

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Gilbert C (2013) The eye signs of vitamin A deficiency. Community Eye Health 26(84):66–67

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Alwitry A (2000) Vitamin A deficiency in coeliac disease. Br J Ophthalmol 84(9):1079–1080

    CAS  PubMed  Google Scholar 

  13. 13.

    Witherspoon SR, Callanan D (2008) Celiac disease presenting as a xerophthalmic fundus. Retina 28(3):525–526

    PubMed  Google Scholar 

  14. 14.

    Chiu M, Dillon A, Watson S (2016) Vitamin A deficiency and xerophthalmia in children of a developed country. J Paediatr Child Health 52(7):699–703

    PubMed  Google Scholar 

  15. 15.

    Apushkin MA, Fishman GA (2005) Improvement in visual function and fundus findings for a patient with vitamin A-deficient retinopathy. Retina 25(5):650–652

    PubMed  Google Scholar 

  16. 16.

    McGeeney BE, Friedman DI (2014) Pseudotumor cerebri pathophysiology. Headache 54(3):445–458

    PubMed  Google Scholar 

  17. 17.

    Hayes KC, McCombs HL, Faherty TP (1971) The fine structure of vitamin A deficiency. II. Arachnoid granulations and CSF pressure. Brain J Neurol 94(2):213–224

    CAS  Google Scholar 

  18. 18.

    Calhoun MC, Hurt HD, Eaton HD, Rousseau JE Jr, Hall RC Jr (1967) Rates of formation and absorption of cerebrospinal fluid in bovine hypovitaminosis A. J Dairy Sci 50(9):1489–1494

    CAS  PubMed  Google Scholar 

  19. 19.

    Libien J, Kupersmith MJ, Blaner W, McDermott MP, Gao S, Liu Y et al (2017) Role of vitamin A metabolism in IIH: results from the idiopathic intracranial hypertension treatment trial. J Neurol Sci 372:78–84

    CAS  PubMed  Google Scholar 

  20. 20.

    Dotan G, Goldstein M, Stolovitch C, Kesler A (2013) Pediatric pseudotumor cerebri associated with low serum levels of vitamin A. J Child Neurol 28(11):1370–1377

    PubMed  Google Scholar 

  21. 21.

    Rani U, Imdad A, Beg M (2015) Rare neurological manifestation of celiac disease. Case Rep Gastroenterol 9(2):200–205

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Raina UK, Goel N, Sud R, Thakar M, Ghosh B (2011) Bilateral total cataract as the presenting feature of celiac disease. Int Ophthalmol 31(1):47–50

    PubMed  Google Scholar 

  23. 23.

    Sari R, Yildirim B, Sevinc A, Buyukberber S (2000) Idiopathic hypoparathyroidism and celiac disease in two patients with previous history of cataract. Indian J Gastroenterol 19(1):31–32

    CAS  PubMed  Google Scholar 

  24. 24.

    Rickels MR, Mandel SJ (2004) Celiac disease manifesting as isolated hypocalcemia. Endocr Pract 10(3):203–207

    PubMed  Google Scholar 

  25. 25.

    Brown CJ, Akaichi F (2015) Vitamin D deficiency and posterior subcapsular cataract. Clin Ophthalmol 9:1093–1098

    CAS  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L (2015) The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res 30(9):1738–1744

    CAS  PubMed  Google Scholar 

  27. 27.

    Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, Mager D (2015) Assessing nutritional quality and adherence to the gluten-free diet in children and adolescents with celiac disease. Can J Diet Pract Res 76(2):56–63

    PubMed  Google Scholar 

  28. 28.

    Reinken L, Zieglauer H (1978) Vitamin B-6 absorption in children with acute celiac disease and in control subjects. J Nutr 108(10):1562–1565

    CAS  PubMed  Google Scholar 

  29. 29.

    Mooney PD, Kurien M, Evans KE, Rosario E, Cross SS, Vergani P et al (2016) Clinical and immunologic features of ultra-short celiac disease. Gastroenterology 150(5):1125–1134

    CAS  PubMed  Google Scholar 

  30. 30.

    Post M, Lubinski W, Lubinski J, Krzystolik K, Baszuk P, Muszynska M et al (2018) Serum selenium levels are associated with age-related cataract. Ann Agric Environ Med 25(3):443–448

    CAS  PubMed  Google Scholar 

  31. 31.

    Ajith TA (2015) Ranimenon. Homocysteine in ocular diseases. Clin Chim Acta 450:316–321

    CAS  PubMed  Google Scholar 

  32. 32.

    Minassian DC, Mehra V, Jones BR (1984) Dehydrational crises from severe diarrhoea or heatstroke and risk of cataract. Lancet 1(8380):751–753

    CAS  PubMed  Google Scholar 

  33. 33.

    Balasubramanian D, Bansal AK, Basti S, Bhatt KS, Murthy JS, Rao CM (1993) The biology of cataract. The Hyderabad cataract research group. Indian J Ophthalmol 41(4):153–171

    CAS  PubMed  Google Scholar 

  34. 34.

    Mollazadegan K, Kugelberg M, Lindblad BE, Ludvigsson JF (2011) Increased risk of cataract among 28,000 patients with celiac disease. Am J Epidemiol 174(2):195–202

    PubMed  Google Scholar 

  35. 35.

    Bahn RS (2010) Graves’ ophthalmopathy. N Engl J Med 362(8):726–738

    CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Roy A, Laszkowska M, Sundstrom J, Lebwohl B, Green PH, Kampe O et al (2016) Prevalence of celiac disease in patients with autoimmune thyroid disease: a meta-analysis. Thyroid 26(7):880–890

    PubMed  Google Scholar 

  37. 37.

    Mormile R (2016) Celiac disease and Hashimoto’s thyroiditis: a shared plot? Int J Colorectal Dis 31(4):947

    PubMed  Google Scholar 

  38. 38.

    Lerner A, Jeremias P, Matthias T (2017) Gut-thyroid axis and celiac disease. Endocr Connect 6(4):R52–R58

    CAS  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Ponto KA, Schuppan D, Zwiener I, Binder H, Mirshahi A, Diana T et al (2014) Thyroid-associated orbitopathy is linked to gastrointestinal autoimmunity. Clin Exp Immunol 178(1):57–64

    CAS  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Ferrari SM, Fallahi P, Ruffilli I, Elia G, Ragusa F, Benvenga S et al (2019) The association of other autoimmune diseases in patients with Graves’ disease (with or without ophthalmopathy): review of the literature and report of a large series. Autoimmun Rev 18(3):287–292

    PubMed  Google Scholar 

  41. 41.

    Kapoor A, Patwari AK, Kumar P, Jain A, Narayan S (2013) Serum soluble interleukin-2 receptor, interleukin-6 and tumor necrosis factor alpha as markers of celiac disease activity. Indian J Pediatr 80(2):108–113

    PubMed  Google Scholar 

  42. 42.

    Mikos H, Mikos M, Obara-Moszynska M, Niedziela M (2014) The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Polska 65(2):150–155

    Google Scholar 

  43. 43.

    Pras E, Neumann R, Zandman-Goddard G, Levy Y, Assia EI, Shoenfeld Y et al (2004) Intraocular inflammation in autoimmune diseases. Semin Arthritis Rheum 34(3):602–609

    CAS  PubMed  Google Scholar 

  44. 44.

    Klack K, Pereira RM, de Carvalho JF (2011) Uveitis in celiac disease with an excellent response to gluten-free diet: third case described. Rheumatol Int 31(3):399–402

    PubMed  Google Scholar 

  45. 45.

    Krifa F, Knani L, Sakly W, Ghedira I, Essoussi AS, Boukadida J et al (2010) Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1. Gastroenterol Clin Biol 34(4–5):319–320

    CAS  PubMed  Google Scholar 

  46. 46.

    Hyrailles V, Desprez D, Beauerere L, de Ferrier F, Larrey D, Ramos J et al (1995) Uveitis complicating celiac disease and cured by gluten-free diet. Gastroenterol Clin Biol 19(5):543–544

    CAS  PubMed  Google Scholar 

  47. 47.

    Mollazadegan K, Kugelberg M, Tallstedt L, Ludvigsson JF (2012) Increased risk of uveitis in coeliac disease: a nationwide cohort study. Br J Ophthalmol 96(6):857–861

    PubMed  Google Scholar 

  48. 48.

    Rosenbaum JT, Lin P, Asquith M (2016) The microbiome, HLA, and the pathogenesis of uveitis. Jpn J Ophthalmol 60(1):1–6

    CAS  PubMed  Google Scholar 

  49. 49.

    Weinstein JE, Pepple KL (2018) Cytokines in uveitis. Curr Opin Ophthalmol 29(3):267–274

    PubMed  Google Scholar 

  50. 50.

    Casella G, Bordo BM, Schalling R, Villanacci V, Salemme M, Di Bella C et al (2016) Neurological disorders and celiac disease. Minerva Gastroenterol Dietol 62(2):197–206

    PubMed  Google Scholar 

  51. 51.

    Arroyo HA, De Rosa S, Ruggieri V, de Davila MT, Fejerman N, Argentinean E et al (2002) Epilepsy, occipital calcifications, and oligosymptomatic celiac disease in childhood. J Child Neurol 17(11):800–806

    PubMed  Google Scholar 

  52. 52.

    Millington RS, James-Galton M, Barbur JL, Plant GT, Bridge H (2015) Severe, persistent visual impairment associated with occipital calcification and coeliac disease. J Neurol 262(9):2056–2063

    CAS  PubMed  Google Scholar 

  53. 53.

    Wu D, Pardridge WM (1999) Blood-brain barrier transport of reduced folic acid. Pharm Res 16(3):415–419

    CAS  PubMed  Google Scholar 

  54. 54.

    Masingue M, Benoist JF, Roze E, Moussa F, Sedel F, Lubetzki C et al (2019) Cerebral folate deficiency in adults: a heterogeneous potentially treatable condition. J Neurol Sci 396:112–118

    CAS  PubMed  Google Scholar 

  55. 55.

    Bernasconi A, Bernasconi N, Andermann F, Dubeau F, Guberman A, Gobbi G et al (1998) Celiac disease, bilateral occipital calcifications and intractable epilepsy: mechanisms of seizure origin. Epilepsia 39(3):300–306

    CAS  PubMed  Google Scholar 

  56. 56.

    Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D (2008) Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol 64(3):332–343

    CAS  PubMed  Google Scholar 

  57. 57.

    Johnson AM, Dale RC, Wienholt L, Hadjivassiliou M, Aeschlimann D, Lawson JA (2013) Coeliac disease, epilepsy, and cerebral calcifications: association with TG6 autoantibodies. Dev Med Child Neurol 55(1):90–93

    PubMed  Google Scholar 

  58. 58.

    Patterson SL, Goglin SE (2017) Neuromyelitis optica. Rheum Dis Clin N Am 43(4):579–591

    Google Scholar 

  59. 59.

    Jarius S, Wildemann B (2010) AQP4 antibodies in neuromyelitis optica: diagnostic and pathogenetic relevance. Nat Rev Neurol 6(7):383–392

    CAS  PubMed  Google Scholar 

  60. 60.

    Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X et al (2010) EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol 17(8):1019–1032

    CAS  PubMed  Google Scholar 

  61. 61.

    Jacob S, Zarei M, Kenton A, Allroggen H (2005) Gluten sensitivity and neuromyelitis optica: two case reports. J Neurol Neurosurg Psychiatry 76(7):1028–1030

    CAS  PubMed  PubMed Central  Google Scholar 

  62. 62.

    Bergamaschi R, Jarius S, Robotti M, Pichiecchio A, Wildemann B, Meola G (2009) Two cases of benign neuromyelitis optica in patients with celiac disease. J Neurol 256(12):2097–2099

    CAS  PubMed  Google Scholar 

  63. 63.

    Jarius S, Jacob S, Waters P, Jacob A, Littleton E, Vincent A (2008) Neuromyelitis optica in patients with gluten sensitivity associated with antibodies to aquaporin-4. J Neurol Neurosurg Psychiatry 79(9):1084

    CAS  PubMed  Google Scholar 

  64. 64.

    Meyts I, Jansen K, Renard M, Bossuyt X, Roelens F, Regal L et al (2011) Neuromyelitis optica-IgG + optic neuritis associated with celiac disease and dysgammaglobulinemia: a role for tacrolimus? Eur J Paediatr Neurol 15(3):265–267

    PubMed  Google Scholar 

  65. 65.

    Danielsson O, Lindvall B, Hallert C, Vrethem M, Dahle C (2017) Increased prevalence of celiac disease in idiopathic inflammatory myopathies. Brain Behav 7(10):e00803

    PubMed  PubMed Central  Google Scholar 

  66. 66.

    Cerman E, Esen F, Eraslan M, Kazokoglu H (2014) Orbital myositis associated with celiac disease. Int Ophthalmol 34(3):635–638

    PubMed  Google Scholar 

  67. 67.

    Katsanos A, Asproudis I, Katsanos KH, Dastiridou AI, Aspiotis M, Tsianos EV (2013) Orbital and optic nerve complications of inflammatory bowel disease. J Crohn’s Colitis 7(9):683–693

    Google Scholar 

  68. 68.

    Felekis T, Katsanos K, Kitsanou M, Trakos N, Theopistos V, Christodoulou D et al (2009) Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single-center study. Inflamm Bowel Dis 15(1):29–34

    PubMed  Google Scholar 

  69. 69.

    Lerner A, Blank M (2014) Hypercoagulability in celiac disease–an update. Autoimmun Rev 13(11):1138–1141

    CAS  PubMed  Google Scholar 

  70. 70.

    Malhi RK, Dhami A, Malhi NS, Soni A, Dhami GS (2018) Central retinal vein occlusion revealing celiac disease: the first report of two cases from India. Indian J Ophthalmol 66(9):1315–1317

    PubMed  PubMed Central  Google Scholar 

  71. 71.

    Jomni T, Bellakhal S, Abouda M, Abdelaali I, Douggui H (2015) An atypical presentation of celiac disease: central retinal vein occlusion. Pan Afr Med J 22:300

    PubMed  PubMed Central  Google Scholar 

  72. 72.

    Lee ES, Pulido JS (2005) Nonischemic central retinal vein occlusion associated with celiac disease. Mayo Clin Proc 80(2):157

    PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dimitrios K. Christodoulou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fousekis, F.S., Katsanos, A., Katsanos, K.H. et al. Ocular manifestations in celiac disease: an overview. Int Ophthalmol 40, 1049–1054 (2020).

Download citation


  • Extraintestinal manifestations
  • Celiac disease
  • Celiac disease
  • Eye
  • Uveitis
  • Dry eye