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

PURPOSE: To investigate sex-related differences in uveitis etiologies through a systematic review and meta-analysis. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.