The Relationship Between Androgens and Ocular Diseases: A Systematic Review and Meta-analysis

• Systematic review and meta-analysis of 127 studies (980,386 adults). • Androgen deprivation therapy linked to lower primary open-angle glaucoma risk. • High-androgen conditions linked to worse dry eye and meibomian gland loss. • Testosterone exposure linked to higher central serous chorioretinopathy risk. • Most other pooled results were imprecise; evidence certainty was low. To determine whether endogenous and exogenous androgen states (deficiency, excess, supplementation, and pharmacologic inhibition) are associated with ocular outcomes in adults. Androgen-altering conditions and therapies are common, yet clinicians lack guidance on ocular risk and surveillance. MEDLINE (PubMed), Embase, Web of Science, and ClinicalTrials.gov were searched from inception to April 14, 2025 (PROSPERO CRD420251033632). Randomized trials and observational studies of adults (≥18 years) with a defined androgen exposure/inhibition and at least 1 ocular outcome were included. Two reviewers independently screened, extracted data, and assessed risk of bias (Joanna Briggs Institute tools). Random-effects meta-analyses were performed and certainty was assessed using GRADE. One hundred twenty-seven studies (980,386 participants) were included. Androgen deprivation therapy was associated with lower odds of primary open-angle glaucoma (k=2; odds ratio OR, 0.68; 95% confidence interval CI, 0.56-0.83). Hyperandrogenic cohorts (predominantly polycystic ovary syndrome) showed worse evaporative dry eye findings, including higher ocular surface disease index scores (k=6; standardized mean difference SMD, 0.40; 95% CI, 0.03-0.77), shorter tear breakup time (k=8; SMD, −0.69; 95% CI, −1.15 to −0.24), and greater meibomian gland loss (k=4; SMD, 1.20; 95% CI, 0.46-1.94). Exogenous testosterone exposure was associated with increased central serous chorioretinopathy risk (k=2; OR, 4.03; 95% CI, 1.38-11.82). Across a heterogeneous and predominantly low-certainty evidence base, androgen status showed domain-specific associations with selected ocular outcomes. These findings should be interpreted as hypothesis-generating and require prospective studies with standardized ocular endpoints, serial androgen measurements, and clearer exposure characterization.