Systematic Review of Postvaccination Ocular Adverse Events: A Comprehensive Analysis of Published Reports

Ocular adverse events following COVID-19 vaccination are well described; however, systematic analyses of non-COVID antiviral vaccines remain limited. This review aimed to evaluate ocular complications associated with non-COVID antiviral immunizations, including influenza, varicella-zoster (VZV), human papillomavirus (HPV), and hepatitis B (HBV) vaccines. A systematic search (PROSPERO CRD4202450873) identified 122 patients (184 eyes) from 8,487 publications, including case reports, case series, and observational studies. Uveitis was the most common (92/184 eyes; 50.0%, 95% CI 42.8%-57.2%), frequently following influenza vaccination (35/122; 28.7%, 95% CI 20.7%-36.7%). Most patients (95/122; 77.9%, 95% CI 70.5%-85.3%) required systemic corticosteroids, reflecting predominant inflammation. Ocular symptoms occurred within 30 days in 84.4% (103/122)of cases, with peak onset at 7-30 days (62/122; 50.8%, 95% CI 42.0%-59.6%). Despite appropriate treatment, 18 patients (20.0%, 95% CI 13.0%-29.4%) experienced persistent inflammation or required therapy beyond 1 month, categorized as "long-vax", defined as ocular symptoms persisting for ≥ 4 weeks after vaccination. Although rare, antiviral vaccine-associated ocular complications may persist, posing a risk of long-term visual morbidity and emphasizing the importance of clinician awareness, postvaccination surveillance, and counseling for patients receiving repeated or combined vaccine exposures.