Clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia: A multicentre cross-sectional study
8 affiliations
- 1Ophthalmology, Boru Meda General Hospital, Dessie, Amhara, Ethiopia
- 2Internal Medicine, Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Amhara, Ethiopia
- 3Public Health Emergency Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia
- 4Clinical Pharmacy, Bahir Dar University College of Medicine and Health Science, Bahir Dar, Ethiopia
- 5College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- 6Department of Optometry, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
- 7School of Public Health, Debre Tabor University College of Health Sciences, Debre Tabor, Ethiopia
- 8Nutrition and Dietetics, Wollo University, Dessie, Ethiopia
Abstract
Objective: To assess the clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia.
Design: Multicentre cross-sectional study.
Setting: Ophthalmic centres in Northern Ethiopia.
Participants: A total of 618 adults were included in the analysis, with a response rate of 97.17%.
Methods: Sociodemographic and clinical data were collected using a pretested structured questionnaire. Dry eye disease was assessed using the Ocular Surface Disease Index, tear break-up time, Schirmer I test and ocular surface staining. Tear samples were collected and analysed for interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α) and matrix metalloproteinase-9 (MMP-9) using standard laboratory procedures. Differences in biomarker concentrations across dry eye disease severity categories were assessed using one-way analysis of variance or appropriate non-parametric tests. Correlations between inflammatory biomarkers and clinical parameters were assessed using Pearson or Spearman correlation coefficients, as appropriate. Ordinal multivariable logistic regression was used to identify factors associated with increasing dry eye disease severity. Statistical significance was set at p<0.05.
Results: The prevalence of dry eye disease was 44.01% (95% CI 40.8% to 48.1%). Concentrations of IL-1β, IL-6, TNF-α and MMP-9 increased significantly across dry eye disease severity categories. MMP-9 demonstrated the strongest correlations with clinical parameters of DED. Female sex (adjusted OR (AOR)=1.62, 95% CI 1.15 to 2.30), diabetes mellitus (AOR=2.18; 95% CI 1.34 to 3.55), screen exposure of ≥3 hours/day (AOR=2.12; 95% CI 1.48 to 3.04), bicycle or motorbike riding (AOR=1.69; 95% CI 1.16 to 2.46) and alcohol consumption (AOR=1.58; 95% CI 1.06 to 2.35) were independently associated with increasing dry eye disease severity.
Conclusion: Dry eye disease was common among adults attending ophthalmic centres in Northern Ethiopia, with inflammatory biomarker concentrations increasing with greater clinical severity. MMP-9 showed the strongest observed association with clinical measures of dry eye disease. These findings suggest that tear film inflammatory biomarkers may have relevance for understanding the biological processes underlying dry eye disease severity, while attention to modifiable associated factors may contribute to improved prevention and management.
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BibTeX
@article{gudayneh2026clinical,
title = {{Clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia: A multicentre cross-sectional study}},
author = {Yitayal Abebe Gudayneh and Alemnew Taye Dires and Damtie Lankir Abebe and Abebech Tewabe Gelaye and Mahlet Gubena Hailu and Getachew Kassahun Desalegn and Simegnew Tilahun Amlaku and Sisay Eshete Tadesse},
journal = {BMJ Open},
year = {2026},
month = sep,
doi = {10.1136/bmjopen-2026-121775},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121775},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia: A multicentre cross-sectional study
AU - Yitayal Abebe Gudayneh
AU - Alemnew Taye Dires
AU - Damtie Lankir Abebe
AU - Abebech Tewabe Gelaye
AU - Mahlet Gubena Hailu
AU - Getachew Kassahun Desalegn
AU - Simegnew Tilahun Amlaku
AU - Sisay Eshete Tadesse
PY - 2026
DA - 2026/09/30
JO - BMJ Open
DO - 10.1136/bmjopen-2026-121775
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-121775
AB - Objective: To assess the clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia. Design: Multicentre cross-sectional study. Setting: Ophthalmic centres in Northern Ethiopia. Participants: A total of 618 adults were included in the analysis, with a response rate of 97.17%. Methods: Sociodemographic and clinical data were collected using a pretested structured questionnaire. Dry eye disease was assessed using the Ocular Surface Disease Index, tear break-up time, Schirmer I test and ocular surface staining. Tear samples were collected and analysed for interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α) and matrix metalloproteinase-9 (MMP-9) using standard laboratory procedures. Differences in biomarker concentrations across dry eye disease severity categories were assessed using one-way analysis of variance or appropriate non-parametric tests. Correlations between inflammatory biomarkers and clinical parameters were assessed using Pearson or Spearman correlation coefficients, as appropriate. Ordinal multivariable logistic regression was used to identify factors associated with increasing dry eye disease severity. Statistical significance was set at p<0.05. Results: The prevalence of dry eye disease was 44.01% (95% CI 40.8% to 48.1%). Concentrations of IL-1β, IL-6, TNF-α and MMP-9 increased significantly across dry eye disease severity categories. MMP-9 demonstrated the strongest correlations with clinical parameters of DED. Female sex (adjusted OR (AOR)=1.62, 95% CI 1.15 to 2.30), diabetes mellitus (AOR=2.18; 95% CI 1.34 to 3.55), screen exposure of ≥3 hours/day (AOR=2.12; 95% CI 1.48 to 3.04), bicycle or motorbike riding (AOR=1.69; 95% CI 1.16 to 2.46) and alcohol consumption (AOR=1.58; 95% CI 1.06 to 2.35) were independently associated with increasing dry eye disease severity. Conclusion: Dry eye disease was common among adults attending ophthalmic centres in Northern Ethiopia, with inflammatory biomarker concentrations increasing with greater clinical severity. MMP-9 showed the strongest observed association with clinical measures of dry eye disease. These findings suggest that tear film inflammatory biomarkers may have relevance for understanding the biological processes underlying dry eye disease severity, while attention to modifiable associated factors may contribute to improved prevention and management.
SN - 2044-6055
SN - 2044-6055
ER -