Sex-Related Effects on the Clinical Presentation of Uveitis

The primary aim of this study was to determine sex-related patterns of uveitic entities. Secondary aims included sex-related patterns of uveitic complications.

Retrospective clinical cohort study.

5703 participants presenting with uveitis from January 2009 to December 2023 were included.

uveitis entities and complications.

2870 (50.3%) participants were female and 2831 (49.6%) were male. Males presented at a significantly younger age than females (42.2 vs 45.0). Significant sex-based differences were observed in the prevalence of specific uveitic conditions. Females were more likely to develop multifocal choroiditis (female: male ratio 1.818:1), Vogt-Koyanagi-Harada syndrome (female: male ratio 2.136:1), birdshot chorioretinopathy (female: male ratio 2.800:1, punctate inner choroidopathy (female: male ratio 6.571:1), drug-induced uveitis (female: male ratio 2.833:1), Crohn's disease (female: male ratio 3.714:1) and multiple evanescent white dot syndrome (female: male ratio 5.000:1). In contrast, males were more likely to develop acute posterior multifocal placoid pigment epitheliopathy (female: male ratio 0.364:1), sympathetic ophthalmia (female: male ratio 0.353:1) and syphilis (female: male ratio 0.404:1). Cataract was significantly more common in females, and this remained significant after adjusting for age at presentation, anatomical location and bilaterality. Cystoid macular edema and epiretinal membrane were more frequent in females, whereas retinal detachment occurred more often in males. Bilateral vision loss occurred in 238 patients (4.2%) and was significantly more common in females (4.9% vs 3.5%).

Sex appears to be a key factor influencing the underlying etiology and clinical course of uveitis. These findings underscore the importance of considering sex as a biological variable in the diagnosis, monitoring, and management of uveitis.