Reply To: Eye Disorders in Children with Celiac Disease

Dear Editor,

We thank Dr. Martins and colleagues for their interest and appreciate their comments on our article. As pointed out in their letter, there has been an increase in the number of reports of patients with neurologic symptoms associated with CD (1-3). Humoral immune mechanism, antibodies to gliadin, immunoglobulin G antibodies to gangliosides, vitamin deficiencies, and direct neurotoxic effect of gluten are proposed mechanisms in the pathogeneses of the neurologic manifestations in CD (4).

Martins et al mentioned intracranial calcifications in patients with CD. We determined only eye disorders in pediatric patients with CD and did not pursue neurologic investigation such as neuroimaging. When we evaluated the patients retrospectively, we observed that none of our patients had neurologic symptoms. Nevertheless, we agree with Martins et al in light of recent reports that neurologic examination should be performed in addition to eye examination in patients with CD. Further studies with larger study groups and longer duration of follow-up are required to clarify how often eye examinations are needed and if neuroimaging is necessary in every patient, even when asymptomatic.