Periodontal disease and glaucoma. A systematic review and Meta-Analysis

Topic To assess the association between periodontal disease and glaucoma in adults through systematic review and meta-analysis of observational studies. Clinical relevance This study suggests that periodontal disease may increase the likelihood of developing glaucoma. Recognizing oral health as a potential modifiable risk factor could promote interdisciplinary prevention strategies and earlier detection of glaucoma in at-risk individuals. Methods This review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42023428738). A systematic search was performed in PubMed/Medline, Scopus, Web of Science, Embase, Cochrane Library, LILACS, Google Scholar and journals with the highest impact in Ophthalmology, available until August 26th, 2025. Eligible articles were independently screened and quality assessed by three reviewers. All observational clinical studies reporting quantitative effect estimates and 95% confidence interval (95%CI) for the association between periodontal disease and glaucoma were included. Effect estimates for the association with glaucoma were pooled using random effects meta-analysis (Review Manager Version 5.4). Results 946 studies were screened, and 6 studies were included in the systematic review: 3 cohort studies, 1 nested case-control study and 2 cross-sectional studies. The populations evaluated were adults (n = 1,153,308). Different diagnostic methods were used for periodontal disease and glaucoma (clinical, self-reported, and disease classification codes), with variations in the criteria used and the type of glaucoma evaluated. Pooled effect estimates indicated a positive association between periodontal disease and glaucoma (OR: 1.72; 95%CI: 1.13–2.63; p-value: 0.010, I ² : 99%). Conclusion The findings of this review, based on observational studies involving over one million individuals, suggest an association between periodontal disease and glaucoma. Patients with periodontal disease appear to be more likely to develop glaucoma than patients without it. However, additional long-term studies are needed.