Researchers from the University of Auckland (UoA) and Moorfields Eye Hospital identified significant sex-related differences in the presentation and complications of uveitis.

The large retrospective study, published in the American Journal of Ophthalmology, analysed 5,703 patients with uveitis, with females making up 50.3% of participants. Men presented at a younger mean age than women (42.2 vs 45.0 years, p<0.001), with distinct sex-related patterns observed across several disease entities. Females were more likely to develop multifocal choroiditis, Vogt-Koyanagi-Harada (VKH) syndrome, birdshot chorioretinopathy, punctate inner choroidopathy, drug-induced uveitis, Crohn’s-related uveitis and multiple evanescent white-dot syndrome, while males were more often affected by acute posterior multifocal placoid pigment epitheliopathy, sympathetic ophthalmia and syphilitic uveitis.

Cataract, cystoid macular oedema and epiretinal membrane were significantly more frequent in females, whereas retinal detachment occurred more often in males. Bilateral vision loss was also higher among women (4.9% vs 3.5%, p=0.008), said authors.

The authors – Drs Rachel Niederer and Jo Sims – attributed these differences to biological and genetic factors, noting the influence of sex hormones and X-chromosome-linked immune genes on autoimmune and inflammatory pathways. “Sex appears to be a key factor influencing the underlying aetiology and clinical course of uveitis,” said lead author Dr Priya Samalia. “These findings underscore the importance of considering sex as a biological variable in diagnosis, monitoring and management.”