Reconsidering the Role of Age in Tear Film Instability: Real-World Evidence From a Specialized Dry Eye Clinic

To examine the association between age and fluorescein tear film break-up time (FBUT) in a large cohort of patients presenting to a specialized dry eye clinic.

This is a retrospective observational analysis of prospectively collected data on 1044 patients referred to or self-presenting at a tertiary/specialized dry eye clinic in Norway. All participants underwent standardized ocular surface examination at initial presentation, including FBUT measurement. Associations between age and FBUT were assessed using Spearman correlation and linear and non-linear regression models, with analyses performed for each eye and stratified by sex.

Age was significantly but weakly correlated with FBUT in both eyes (Spearman's r -0.16 to -0.27, p < 0.001). Age explained less than 4% of the variance in FBUT, and neither linear nor non-linear models identified a strong age-dependent decline in tear film stability.

In this symptomatic clinical population, age was only weakly associated with FBUT, indicating that tear film instability at presentation likely reflects disease-related and contextual factors rather than chronological aging alone. Importantly, the findings presented herein apply to a symptomatic clinical population.