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 45 months. 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.