Ophthalmic Manifestations of Celiac Disease in the Middle East and North Africa (MENA) Region: A Systematic Review

Celiac disease (CD) is a chronic autoimmune enteropathy triggered by gluten ingestion in genetically predisposed individuals. Beyond gastrointestinal (GI) symptoms, CD can present with diverse systemic complications, yet ophthalmic manifestations remain poorly studied. The Middle East is a high-prevalence region due to genetic susceptibility and wheat-based diets. This review aimed to evaluate CD research in the Middle East and North Africa (MENA) region, focusing on gastroenterological features and ophthalmic involvement. We conducted a systematic review of published studies on CD in MENA populations. PubMed, Scopus, Embase, and Web of Science were searched from inception to September 2025. Eligible studies included original data on CD diagnosis, clinical characteristics, and reported ophthalmic manifestations. Study quality was appraised independently by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools. A total of 24 studies were included, encompassing both pediatric and adult populations across multiple MENA countries. Half of the studies (12/24) reported at least one ophthalmic manifestation. Reported ocular findings ranged from inflammatory and neuro-ophthalmic conditions, including uveitis, optic neuritis, optic neuropathy, and orbital myositis, to vascular and retinal abnormalities such as central retinal vein occlusion and pachychoroid spectrum disease. Dry eye disease was among the most frequently reported manifestations. Several studies also identified subclinical ocular changes, including alterations in choroidal thickness, retinal nerve fiber layer thickness, tear film parameters, and retinal microvascular perfusion. However, the available evidence was heterogeneous, predominantly derived from cross-sectional studies and isolated case reports, and varied considerably regarding diagnostic methods and ophthalmic assessment protocols. Ophthalmic abnormalities have been reported across several MENA populations with CD, involving the ocular surface, uveal tract, optic nerve, and retinal structures. However, the available evidence is insufficient to determine their true prevalence, establish causality, or confirm an increased risk compared with the general population. The predominance of studies from a limited number of countries, particularly Türkiye, further restricts regional generalizability. Future multicenter prospective studies using standardized CD diagnostic criteria and ophthalmic assessment protocols are needed to determine the prevalence and clinical significance of ocular involvement in CD.