Ocular Features of Q Fever: A Systematic Review of Case Series and Case Reports

Introduction: Q fever, caused by Coxiella burnetii, can manifest with ocular involvement and cause significant visual morbidity. This systematic review aims to summarise the reported ocular presentations of Q fever, treatments and clinical outcomes. Materials and Methods: The English-language literature indexed in Web of Science, Ovid Embase, and Ovid MEDLINE was systematically searched from database inception to 25 October 2026 for case reports and case series describing ocular manifestations of Q fever. Data on demographics, exposure history, ocular diagnosis, disease stage, treatment and clinical outcomes were extracted and pooled descriptively. Results: A total of 19 articles, comprising 16 case reports and 3 case series, described 28 patients with ocular manifestation of Q fever. Among the 21 cases with exposure data, 13 (61.9%) had documented occupational or environmental exposure. Intraocular inflammation was the most frequently reported manifestation (20/28, 71.4%), while nine patients presented with neuro-ophthalmic manifestations. Among 18 patients with reported clinical outcomes, 7 (38.9%) achieved recovery without reported sequelae, 8 (44.4%) showed improvement with residual abnormalities, and 3 (16.7%) experienced no improvement or deterioration. Conclusions: Q fever encompasses diverse ocular inflammatory and neuro-ophthalmic manifestations, with the posterior segment being the most commonly affected. Q fever serology may be considered in selected patients with unexplained uveitis or retinitis, particularly in endemic areas.