Smoking and Risk of Uveitis: A Systematic Review and Meta-Analysis

Uveitis is a relatively common eye condition that can lead to substantial symptoms and visual impairment. Identifying modifiable risk factors is essential for effective prevention and management. This systematic review and meta-analysis aimed to assess the causal role of smoking in uveitis by summarizing existing evidence on its impact on pathogenesis, disease progression, and treatment outcomes.

A comprehensive search was conducted in Ovid MEDLINE and Embase in December 2024. Studies were eligible if they included an ophthalmologist-confirmed diagnosis of uveitis and reported on smoking exposure. Exclusion criteria were pediatric populations, case reports/series, interventional studies, and studies involving patients with systemic disease to minimize confounding. The review followed PRISMA guidelines and a pre-registered PROSPERO protocol (CRD42025641517). Risk of bias was assessed using Joanna Briggs Institute tools. Data were extracted by one reviewer and verified by another. Meta-analyses were performed using RevMan, with heterogeneity evaluated by I². Certainty of evidence was assessed using GRADE methodology.

Of 892 articles screened, seven met inclusion criteria: four retrospective case-control studies, one retrospective cohort study, and two cross-sectional studies. The pooled odds ratio (OR) for the association between smoking and uveitis was 1.97 (95% CI, 1.71-2.27) across 1557 individuals with uveitis and 4293 controls. The effect was statistically significant (Z = 9.42; p < 0.00001). Former smokers also had an increased risk (OR 1.23), and smokers showed a tendency toward more complications.

Smoking is a significant and modifiable risk factor for uveitis. These findings support the integration of smoking cessation into clinical management and prevention strategies.