ArticleBMJ open2026
Clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia: A multicentre cross-sectional study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo assess the clinical severity of dry eye disease and its association with tear film inflammatory biomarkers among adults in Northern Ethiopia.
designMulticentre cross-sectional study.
settingOphthalmic centres in Northern Ethiopia.
participantsA total of 618 adults were included in the analysis, with a response rate of 97.17%.
methodsSociodemographic 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.
resultsThe 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.
conclusionDry 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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