Sex-based differences in ocular trauma: a systematic review with narrative synthesis.

Background: Ocular trauma is a major cause of preventable visual impairment and blindness worldwide. Although sex-based differences in ocular trauma have been reported, the evidence has not been comprehensively synthesized across mechanisms, injury patterns, severity, and outcomes. Methods: We conducted a systematic review with narrative synthesis of studies published between January 2000 and December 2025. A structured search was performed in PubMed/MEDLINE, and reference lists of eligible articles were manually screened for additional studies. Original human epidemiologic or clinical studies were eligible if they focused on ocular trauma and reported sex-disaggregated data or direct comparisons between males and females relevant to epidemiology, mechanism, injury pattern, severity, management, or outcome. Reviews, meta-analyses, editorials, letters, conference abstracts, case reports, and mechanistic or preclinical studies were excluded from the formal review. Owing to substantial heterogeneity, findings were synthesized narratively. Forty-seven primary human studies met the inclusion criteria. Results: Males consistently accounted for most ocular trauma cases and were more likely to sustain occupational, sports-related, penetrating, and open-globe injuries, including intraocular foreign bodies, with greater posterior segment involvement and poorer visual outcomes. Females were more commonly represented in domestic, fall-related, blunt, and violence-related injuries. Boys showed higher pediatric injury rates, whereas older women were more vulnerable to fall-related trauma. Conclusion: Ocular trauma shows clinically meaningful sex-based differences that may inform prevention, risk stratification, and patient management.