Acute tear-film disruption in treatment-naive acute anterior uveitis: A retrospective case-control study

The study aimed to quantify the acute tear-film disruption in treatment-naive, 1st-onset noninfectious acute anterior uveitis (AAU) and identify independent and modifiable determinants. Retrospective case-control study enrolling 180 AAU eyes and 90 age-/sex-matched healthy controls. Same-day noninvasive tear breakup time (NIBUT), tear meniscus height, Schirmer-I and Ocular Surface Disease Index were extracted. Multivariable linear regression with bootstrap correction determined predictors of shorter NIBUT. Mean NIBUT was 4.7 seconds lower in AAU than controls (5.7 ± 1.5 seconds vs 10.4 ± 1.5 seconds; P < .001); 66% of AAU eyes versus 2% of controls had NIBUT ≤ 5 seconds. Tear meniscus height (-81 μm), Schirmer-I (-5.3 mm) and Ocular Surface Disease Index (+24 points) all worsened (P < .001). Independent reductions in NIBUT: anterior-chamber cells ≥ 2+ (-1.79 seconds), flare ≥ 3+ (-1.23 seconds), concomitant meibomian gland dysfunction (-0.96 seconds) and daily screen time > 8 hours (-0.59 seconds); adjusted R2 = 0.38, optimism-corrected R2 = 0.35. In this proof-of-concept study, 1st-onset AAU was associated with measurable tear-film destabilization driven by intraocular inflammatory load. While these findings suggest a potential role for early ocular-surface protection, effect sizes represent upper-bound estimates requiring confirmation in unscreened populations before routine clinical application.