Traditional Eye Medicine in Indigenous and Rural Populations: A Systematic Review of Prevalence, Determinants, and Clinical Outcomes

PURPOSE: Traditional eye medicine (TEM) is widely used in indigenous and rural communities. Understanding its prevalence, determinants, and clinical implications is essential for developing safe, evidence-informed complementary practices. METHODS: A systematic review following PRISMA guidelines searched PubMed, Scopus, Web of Science, and Google Scholar through September 30, 2025. Observational studies reporting TEM prevalence, motivations, or clinical outcomes were included. Findings were synthesized narratively due to heterogeneity. PROSPERO: CRD42025110795. RESULTS: From 3813 records, 10 studies from Africa, Asia, and Latin America were included. TEM prevalence ranged from 18% to 79%, with higher use reported in rural populations and among individuals with ocular symptoms. Most remedies were plant-based; some contained irritants or unsterile components. Users were predominantly female, older, low-income, less educated, and rural. Key predictors included rural residence, family history, prolonged symptoms, distance from hospitals, and limited media access. TEM use was consistently associated with delayed presentation, larger corneal ulcers, worse visual outcomes, higher complication rates, and increased surgical interventions. Training traditional healers improved knowledge and referrals. Overall evidence was low to very low, moderate for prospective cohorts. CONCLUSIONS: Across the included observational studies, traditional eye medicine use was associated with delayed presentation and poorer clinical outcomes; however, the certainty of evidence was low to very low, and study design limitations and residual confounding may influence these associations.