Incidence of Ocular Manifestations After Adult-Onset IBD Remains Stable Over 20 Years
A new retrospective cohort study published in Inflammatory Bowel Diseases indicates that ocular manifestations (OMs) among adults with inflammatory bowel disease (IBD) are uncommon and incidence rates are stable.
However, the authors noted, OMs may be markers of more severe disease, and are more prevalent among patients with Crohn’s disease than among those with ulcerative colitis.
Study Findings
The retrospective cohort included 15,035 adults with newly diagnosed IBD—51.8% Crohn’s disease (CD) and 48.2% ulcerative colitis (UC)—over 20 years within a large Israeli health maintenance organization. Over 119,669 person-years, 349 patients developed OMs, including uveitis, episcleritis/scleritis, or orbital inflammation.
The overall incidence rate was 2.9 per 1000 person-years (95% CI, 2.62–3.24). OM incidence was significantly higher in CD than UC (log-rank P < .001) and remained stable over the 2-decade study period (P = .125). The median time to OM onset was 45 months after IBD diagnosis.
In Crohn’s disease, female sex (hazard ratio [HR], 1.62; 95% CI, 1.24–2.13) and systemic corticosteroid use (HR, 1.62; 95% CI, 1.18–2.22) independently increased risk. Among ulcerative colitis patients, both corticosteroid therapy (HR, 2.17; 95% CI, 1.40–3.37) and intestinal surgery (HR, 3.50; 95% CI, 1.69–7.28) were associated with higher OM incidence.
Clinical Implications
Although ocular involvement occurs in a small proportion of IBD cases, the findings underscore the importance of multidisciplinary care involving gastroenterologists and ophthalmologists. Early recognition of ocular symptoms—such as redness, pain, or photophobia—is essential to prevent vision-threatening complications.
The stable incidence over 20 years suggests consistent patterns in IBD-related systemic inflammation rather than an increase in extraintestinal disease burden. The identified risk factors—female sex, corticosteroid exposure, and surgical intervention—highlight patient subgroups requiring closer ophthalmologic monitoring. Clinician awareness, early detection, and multidisciplinary management remain essential to improving outcomes.
This 20-year Israeli cohort study provides valuable epidemiologic insight into ocular complications in adult-onset IBD. While infrequent, these manifestations warrant vigilance in high-risk patients to ensure timely detection and intervention.
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Reference:
Yanai H, Achler T, Ben-Tov A, et al. Incidence of ocular manifestation after adult-onset inflammatory bowel disease: a 20-year population-based cohort study. Inflamm Bowel Dis. 2025;izaf213. doi:10.1093/ibd/izaf213
