Background: The exposure patterns of respirable crystalline silica based on environmental records, as well as the link to different diseases, are not well described. Aims and objectives: In this study, we evaluated the risk for various diseases in relation to occupational silica exposure, including Silicosis, pulmonary tuberculosis (TB), Autoimmune disorders (AIDs) and Renal diseases. Methods: We assessed the relationship between silica exposure and the rate of various diseases such as silicosis, pulmonary TB, AIDs and renal diseases in a cross-sectional study. We reviewed the medical records and exposure level of workers exposed to silica during the past two decades. Results: 261 workers were included in the study, total duration of exposure 15.6 years (±SD 8.74); 42.15% of them were employed in the artificial marble industry and 29.5% in manufacturing and construction industries. The average yearly silica exposure levels were 0.23 mg/m3 (±0.34). The average cumulative silica concentration was 3.59 mg/m3/y (±4.80). We found 25 (9.58%) incident cases of silicosis, 10 cases of chronic obstructive pulmonary disease (COPD) and emphysema (3.83%), six cases of several AIDs (2.30%), five cases of pulmonary TB (1.92%), three cases of renal diseases (1.15%), two cases of sarcoidosis (0.77%) and no lung cancer cases. When compared to studies with the same endpoint we found excess risk of silicosis (RR = 2.67/0.13 = 20.5, 95% CI 9.85 to 42.86)), pulmonary TB (RR = 30.70, CI 3.43–274.49, p = 0.002) and AIDs (RR = 2.87, 95% CI = 1.27 to 6.48 p = 0.01). Conclusions: Silica exposure was a significant risk factor for silicosis, pulmonary TB and AIDs. Our findings are important given persistent worldwide silica-related epidemics in low and high-income countries.