Incidence of Ocular Manifestation After Adult-Onset Inflammatory Bowel Disease: A 20-Year Population-Based Cohort Study

Background Ocular manifestations (OMs) are recognized extraintestinal complications in inflammatory bowel disease (IBD), but their incidence remains understudied. We aimed to evaluate the incidence and trends of OM in a large population-based cohort of adults with newly diagnosed IBD over the past 2 decades. Methods We conducted a retrospective cohort study including all adult-onset IBD patients between 2005 and 2024 in a large health maintenance organization. Patients with pre-existing OM diagnoses were excluded. The primary outcome was incident OM (uveitis, episcleritis/scleritis, or orbital inflammation) after IBD diagnosis. Annual incidence trends were assessed using the Cochran-Armitage test. Risk factors were analyzed via multivariable Cox regression, stratified by IBD type. Results Among 15 035 newly diagnosed IBD patients (51.8% Crohn’s disease [CD], 48.2% ulcerative colitis [UC]), 349 developed an OM over 119 669 person-years (incidence: 2.9 per 1000 person-years; 95% confidence interval [CI], 2.62-3.24). OM incidence was higher in CD than UC (log-rank P <.001) and remained stable over time (P =.125). The median time to OM was 45months. In CD, 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) were significant risk factors. In UC, corticosteroids (HR, 2.17; 95% CI, 1.40-3.37) and intestinal surgery (HR, 3.50; 95% CI, 1.69-7.28) were associated with increased OM risk. Conclusion OMs in adult-onset IBD are infrequent but clinically relevant, particularly among CD patients and those with markers of severe disease. Clinician awareness and early referral remain essential for prompt diagnosis and management.