A recent study set out to determine which factors trigger inflammatory episodes of recurrent acute anterior uveitis (RAAU), a disease responsible for 10% to 15% of blindness in the US. Stress and inadequate sleep were shown to be the two biggest predictors of future uveitis episodes. 

This case-control study, conducted in Bangkok, included 78 RAAU patients over the age of 18. Participants completed an interview questionnaire asking them about potential factors associated with a uveitis attack, such as average sleep and exercise time, smoke and alcohol consumption, prodromal symptoms, low back pain, anxiety, life events, financial problems, eye trauma, accident, history of an illness and stress. Patients reported on the presence of these factors during the month before their most recent attack. They also underwent a stress test. 

Higher levels of stress and lack of sleep were associated with impending uveitis attacks in RAAU patients. “The odds of uveitis attack within the following month were about nine times in those with stress, and 12 times with sleep deprivation,” the researchers wrote in their paper. “It appeared that other suspected factors, including exercise time, smoking, joint pain or alcohol consumption, were not significantly correlated with the uveitis attack.” No life events were reported by patients in the questionnaire, so it’s not known whether one could trigger a uveitis episode. 

Lack of sleep was defined as getting less than the nightly seven hours recommended by the National Sleep Foundation. Sleep deprivation has been shown to alter immune system function over time, as well as increase C-reactive protein levels and upregulation of interleukin-6 and tumor necrosis factor. The upsurge of inflammatory cytokines may be what triggers the inflammatory attack in RAAU patients. As for stress, it may also activate the hypothalamic–pituitary–adrenal axis, leading to an altered immune response.

Repetitive episodes of intraocular inflammation pose the risk of tissue damage, glaucoma, cystoid macular edema, cataract and permanent visual disability. Inform your patients that keeping stress levels low and getting adequate sleep each night (seven to nine hours) may help offset the frequency of uveitis episodes. 

Neti N, Pimsri A, Boonsopon S, et al. Triggering factors associated with a new episode of recurrent acute anterior uveitis. Sci Rep. 2021;11:12156.