Sex Differences in Uveitis Etiology: A Systematic Review and Meta-Analysis

To investigate sex-related differences in uveitis etiologies through a systematic review and meta-analysis.

PubMed/MEDLINE, Scopus, CENTRAL, and Web of Science were searched for studies published between January 2015 and January 2025. Eligible cohort or cross-sectional studies reported sex-disaggregated data on known uveitis etiologies. Three reviewers independently screened studies, extracted data, and assessed quality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects Mantel-Haenszel models, with RR > 1 indicating female predominance and RR < 1 male predominance. Heterogeneity was assessed using I2. The review followed PRISMA guidelines and was preregistered in PROSPERO (CRD42024531037).

Of 2,465 records, 19 studies met inclusion criteria, conducted across Asia, Europe, South America, the Middle East, and Africa. Several autoimmune-associated etiologies were relatively more frequent among females: systemic lupus erythematosus (RR 2.44, 95% CI 1.41-4.22), multiple sclerosis (RR 2.39, 1.57-3.66), sarcoidosis (RR 2.02, 1.33-3.07), juvenile idiopathic arthritis (RR 1.86, 1.26-2.75), and Vogt-Koyanagi-Harada disease (RR 1.45, 1.16-1.80). Several were more frequent among males: Behçet's disease (RR 0.52, 0.36-0.75), sympathetic ophthalmia (RR 0.49, 0.34-0.71), syphilitic uveitis (RR 0.41, 0.28-0.60), and ankylosing spondylitis-associated uveitis (RR 0.55, 0.47-0.65).

Sex-related differences were observed within the included specialist cohorts. Autoimmune-associated uveitis was relatively more frequent among females, whereas HLA-B27-associated and certain infectious etiologies were more frequent among males. Recognition of these patterns may support diagnostic evaluation in specialist settings, but should not be interpreted as universal sex-specific prevalence patterns across all uveitis populations.