Ocular Manifestations of Inflammatory Bowel Disease in Saudi Arabia: A Systematic Review of the Past 13 Years

Ocular extraintestinal manifestations (O-EIMs) in inflammatory bowel disease (IBD) are significant but often underrecognized complications that can affect patient outcomes. In Saudi Arabia, limited data exist on the prevalence, clinical patterns, and management of O-EIMs in IBD patients. This systematic review evaluates existing research to provide a comprehensive analysis of O-EIM burden, highlighting prevalence clinical manifestations and treatment gaps. This review was conducted following PRISMA guidelines. A comprehensive search of PubMed, Scopus, Cochrane Library, Google Scholar, and Web of Science was performed for studies published between January 2012 and January 2024. Inclusion criteria were original studies—including crosssectional, case-control, and cohort (prospective or retrospective) designs—that reported on the prevalence, clinical manifestations, or treatment of O-EIMs in IBD patients in Saudi Arabia. Exclusion criteria comprised non-English publications, non-original articles (e.g., reviews, editorials), studies lacking relevant clinical outcomes, and those with major methodological flaws. Seven articles were included that provided data on O-EIM prevalence, risk factors, and treatment approaches among Saudi IBD patients. The prevalence of O-EIMs ranged from 0.5% to 2.8%, except for one study reporting 76.9%, which relied on self-reported surveys. Episcleritis and uveitis were the most common conditions, with episcleritis significantly associated with IBD flares. Despite their clinical impact, only 9.7% of affected patients received ophthalmology referrals. Medical management across the reviewed studies focused on controlling disease activity. O-EIMs were addressed in limited studies, with treatment modalities including topical corticosteroids, lubricants, antibiotics, NSAIDs, and surgical interventions. Findings indicate that O-EIMs are underdiagnosed and undertreated in Saudi IBD patients. Improved screening protocols, interdisciplinary collaboration, and ophthalmologic referral pathways are needed to enhance early detection and optimize patient care.