Inflammatory Bowel Disease a Risk Factor for Dry Eye Disease, Study Finds

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New results from a large, population-based cohort study in Taiwan identified inflammatory bowel disease (IBD) as an independent risk factor for dry eye disease (DED) and ocular surface damage.¹

According to the analysis, individuals with IBD experienced a significantly higher risk of DED and secondary Sjögren’s syndrome than non-IBD control patients. A significant association was observed between IBD and ocular surface damage, particularly recurrent corneal erosion.

“Gastroenterologists treating patients with IBD should be aware of these possible sight-threatening complications and refer patients with corneal manifestations to ophthalmologists for evaluation and management,” wrote the investigative team, led by Ying-Hsuan Tai and Chia-Yu Kao, of the department of anesthesiology, Shuang Ho Hospital, Taipei Medical University.

Global incidence rates of IBD have risen in recent years, but its pathogenesis remains unclear, with potential causes including genetic factors, the gut microbial, the environment, and immunological abnormalities. The disease primarily involves the gastrointestinal wall, but studies suggest a potentially detrimental effect on extraintestinal systems, including the eye.²

However, the relationship between IBD and DED is unclear, owing to a lack of evidence from previous studies, due to a small patient sample, simple-institution settings, and inadequate adjustment for confounding. In addition, the long-term risk and epidemiology of ocular surface damage in IBD has not been previously estimated.¹

Using administrative data from the National Health Insurance database in Taiwan, the investigative team examined the risk of DED, and corneal surface damage associated with IBD. Participants were considered as having developed IBD only if the diagnosis was established by board-certified physicians and the disease occurred at ≥2 outpatient visits between January 2002 - June 2013. Those with a previous diagnosis of dry eye or corneal diseases were excluded from the analysis.

The primary outcome assessed was DED, defined as the diagnosis established ≥2 times in conjunction with the prescription of cyclosporine ophthalmic emulsion treatment by board-certified ophthalmologists. DED was additionally classified into Sjögren’s syndrome (SS)-related or non-SS-related subtypes. Secondary outcomes included serious types of ocular surface damage, including corneal ulcers, recurrent corneal erosion, and corneal opacity.

Overall, the analysis included 53,293 matched pairs of IBD and non-IBD patients, with a median follow-up time of 8.3 years. Over the study period, 3421 patients with IBD developed DED for an incidence rate of 8.18 cases per 1000 person-years. Meanwhile, 2295 non-IBD controls were diagnosed with DED, for an overall incidence rate of 5.42 cases per 1000 person-years.

Following adjustment for confounders, the analysis showed statistically significant associations between IBD and DED (adjusted hazard ratio [aHR], 1,43; 95% CI, 1.35 - 1.51; P <.0001). In addition, there were statistically significant associations for Sjögren’s syndrome-related (aHR, 1.67; 95% CI, 1.46 – 1.90; P <.0001) and non-Sjögren’s syndrome-related subtypes (aHR, 1.38; 95% CI, 1.38; 95% CI, 1.30 – 1.46; P <.0001).

A total of 1003 patients with IBD were diagnosed with corneal surface damage (2.34 cases per 1000 person-years) and 866 non-IBD controls developed corneal surface damage (2.02 cases per 1000 person-years). Multivariable models revealed IBD was significantly associated with increased corneal surface damage (aHR, 1.13; 95% CI, 1.03 – 1.24; P = .0094), particularly recurrent corneal erosion (aHR, 1.52, 95% CI: 1.22 – 1.88, P = .0002).

Other independent factors for corneal surface damage included age (aHR, 1.003), male versus female sex (aHR, 0.85), and monthly insurance premiums ($501-$800 vs. 0-$500: aHR, 1.45; ≥$801 versus 0–500 US dollars: aHR, 1.32). Based on these factors, Investigators suggested more attention be given to those at high risk of corneal injury, in order to promote overall vision health.

"Our results highlight the importance of regular ophthalmology follow-up for potential corneal surface damage in patients with IBD,” investigators wrote. “Early diagnoses and intervention for ocular complications are pivotal in improving the quality of life and reducing the economic burden in IBD patients.”

References

1. Ko YT, Wu YM, Wu HL, et al. Inflammatory bowel disease and the associated risk of dry eye and ocular surface injury: a nationwide matched cohort study. BMC Ophthalmol. 2023;23(1):415. Published 2023 Oct 13. doi:10.1186/s12886-023-03165-z
2. Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal manifestations of inflammatory bowel disease: Current concepts, treatment, and implications for disease management. Gastroenterology. 2021;161:1118–32