New Episodes of Recurrent Acute Anterior Uveitis Linked to Stress, Sleeplessness

Close-up of the eye of an elderly patient, showing acute anterior uveitis. The sclera (white of the eye) is bloodshot. Uveitis is an inflammation of the uvea of the eye (colored iris, lens muscles, blood vessels supplying the retina). Usually it is an autoimmune disorder in which the immune system attacks it’s own body, although uveitis may be caused by an infection.
Study demonstrates the impact of lifestyle factors on the inflammatory condition.

Among patients with recurrent acute anterior uveitis, inadequate sleep and stress can be triggering factors for uveitis attack, according to research published in Scientific Reports

A team of investigators in Thailand conducted a matched case-control study to determine the potential triggering factors associated with a recent episode of uveitis in individuals with recurrent acute anterior uveitis compared with patients in quiescence stage of disease. Comparisons included in-person or telephone interview questionnaires about patient stress, sleep time, life events, alcohol intake, smoking, exercise, financial burdens, and joint pain. 

The study included 78 patients with recurrent acute anterior uveitis; 39 patients were assigned to the case group (mean age, 50.7 years) and 39 patients (mean age, 50.9 years) were assigned to the control group. The majority of patients in both groups were women (64.1% each) and most patients were positive for human leukocyte antigen-B27 (HLA-B27; 82.1% each). Unilateral anterior uveitis was also common in the majority of patients, with 97.4% of the case cohort and 94.9% of the control cohort. 

The prevalence of previous episodes of recurrent uveitis were comparable between the 2 groups (median 2 times in each group). Underlying immunologic diseases were present in 43% of the case group and in 41.03% of the control group, with slightly more frequent proportions of patients using concurrent anti-inflammatory medications for rheumatologic diseases in the control group compared with the case group (20.5% vs 15.4%, respectively). 

In a univariate analysis, patients in the case group had statistically significantly higher levels of stress, reported by the Srithanya Stress Test (ST-5) scoring (P <.003) and more instances of less than 7 hours of sleep per day (P <.003) compared with patients in the control group. Results for exercise, alcohol intake, joint pain, anxiety, and financial burden were not found to be significantly different between groups. 

Results from a multivariate conditional analysis that were adjusted for possible triggering factors, age, sex, and HLA-B27 typing also resulted in significant levels of stress (ST-5 score of 3 or more) and less than optimal sleep. These outcomes were more likely to result in an episode of acute anterior uveitis with an adjusted odds ratio of 9.07 for stress (P =.037) and an adjusted odds ratio of 12.12 for sleep (P =.025). 

“These associations emphasize the importance of mental and behavioral management to support the control of anterior uveitis,” according to investigators. “Being aware of stress level and sleep time may prevent repetitive ocular inflammations and protect the [recurrent acute anterior uveitis] patients from the potentially sight-threatening complications. Therefore, relieving their stress and having enough sleep time should be added to [recurrent acute anterior uveitis] patients’ advice.”


Neti N, Pimsri A, Boonsopon S, Tesavibul N, Choopong P. Triggering factors associated with a new episode of recurrent acute anterior uveitis. Sci Rep. 2021;11(1):12156. doi:10.1038/s41598-021-91701-6