Bilateral lid margin ulcers as the initial manifestation of Crohn disease.

Purpose: To report an unusual bilateral ulcerative lid involvement as the presenting manifestation of a severe Crohn disease.

Design: Observational case report.

Method: Description of an otherwise healthy woman who initially presented with bilateral ulcerative lid involvement before the discovery of an extensive ulcerative intestinal inflammatory disease.

Results: A 32-year-old woman presented with bilateral ulcerative blepharitis. She also complained of aphthous oral lesions and diarrheic episodes for the previous 3 days. Impression cytology of the lid ulcers showed conjunctival cells, together with the presence of lymphocytes and macrophages. Colonoscopy and colonic biopsy were characteristic of Crohn disease. The treatment with systemic corticosteroids healed bowel, oral, and lid margin ulcerative lesions.

Conclusion: The simultaneous appearance of ulcerative lesions in the intestinal mucosa and in the mucocutaneous lid margin and the comparable features encountered in the cytologic studies indicate that ulcerative lid margin disease could be an ocular manifestations of Crohn disease.