Meta-Analysis Reveals Higher Risk of Dry Eye in Patients with Inflammatory Bowel Disease
Canada: Dry eye syndrome (DES) emerges as a frequently overlooked extraintestinal manifestation of inflammatory bowel disease (IBD), a systematic review and meta-analysis published in Frontline Gastroenterology has revealed.
The review, led by Bachviet Nguyen and colleagues from the University of British Columbia, Vancouver, reveals that patients with IBD are at significantly higher risk of developing DES, highlighting the need for clinicians to actively screen for ocular complications in this population.
The meta-analysis pooled data from eight cohort studies encompassing 55,211 patients with IBD and 54,870 controls without IBD. Researchers examined objective ocular parameters, including tear production (Schirmer I test), tear film stability (tear breakup time, TBUT), and symptom severity (Ocular Surface Disease Index, OSDI). The results demonstrate that IBD patients experience measurable impairment in both tear production and tear film stability, along with more severe dry eye symptoms, compared with non-IBD controls.
Key findings from the review include:
- Increased risk of DES: IBD patients had more than double the odds of developing dry eye syndrome compared with controls (OR=2.54).
- Higher symptom burden: OSDI scores were significantly elevated in the IBD group, with a weighted mean difference (WMD) of 4.57 points, indicating more pronounced dry eye symptoms.
- Reduced tear production: The Schirmer I test showed that IBD patients produced less tear volume than controls (WMD −3.63 mm), suggesting impaired lacrimal function.
- Tear film instability: Tear breakup time (TBUT) was shorter in IBD patients (WMD −3.33 s), reflecting compromised ocular surface stability.
This meta-analysis highlights that DES may be an underrecognized manifestation of IBD, alongside well-known ocular extraintestinal manifestations such as uveitis, scleritis, and episcleritis. While these conditions are often monitored during routine care, dry eye has not traditionally been prioritized, despite its substantial impact on patient comfort and quality of life.
According to the authors, early recognition and treatment of DES in IBD patients could significantly improve daily functioning and overall well-being. They recommend that gastroenterologists and primary care providers incorporate routine ocular assessments into evaluations of IBD patients, particularly for those reporting eye discomfort or visual disturbances. Interventions such as artificial tears, anti-inflammatory eye drops, and lifestyle modifications may alleviate symptoms and prevent long-term ocular damage.
As the prevalence of IBD continues to rise worldwide, this review serves as a reminder that management should extend beyond the gastrointestinal tract. By acknowledging and addressing underappreciated manifestations like dry eye syndrome, clinicians can deliver more holistic care, enhancing both physical comfort and quality of life for patients living with chronic inflammatory disease.
Reference:
Nguyen B, Quon S, Tao BK, et alDry eye syndrome: an underappreciated extraintestinal manifestation of inflammatory bowel disease? A systematic review and meta-analysisFrontline Gastroenterology Published Online First: 19 September 2025. doi: 10.1136/flgastro-2025-103356
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