Evaluation of Risk Factors and Predictive Biomarkers in Ocular Inflammatory Diseases: A Receiver Operating Characteristic Curve-Based Study

Abstract

Ocular inflammatory diseases represent a multifactorial health problem whose occurrence and progression depend on the interaction of environmental, occupational, clinical, biological, and oxidative stress-related factors. Although the eye possesses natural defense mechanisms, including tears, eyelids, and local immune responses, it remains highly susceptible to external aggressors that may induce bacterial, viral, and allergic inflammation. The aim of this study was to investigate the main risk factors associated with these different forms of ocular inflammation and to evaluate the diagnostic value of selected biological and oxidative stress markers. Our socioeconomic risk factors study based on a questionnaire involving 121 participants, including 61 healthy individuals and 60 patients suffering from ocular inflammation. In addition, a biological study was conducted on 38 volunteers in order to analyze selected biological markers (Hematological, Biochemical and oxidative stress markers) related to inflammation. The results obtained in this study highlighted the diversity of factors involved in ocular inflammation. Bacterial ocular infections were strongly associated with several environmental and occupational exposures, particularly dust exposure (OR = 100.000), machine and factory smoke (OR = 44.348), foreign body entry into the eye (OR = 28.889), and industrial work (OR = 15.818), indicating that environmental and workplace conditions play a major role in the development and aggravation of bacterial ocular inflammation. Clinical factors also showed significant associations, with eye rubbing emerging as the strongest risk factor (OR = 140.000), followed by the use of antibiotic eye drops (OR = 95.145), severe ocular itching (OR = 52.308), and family history (OR = 12.727), suggesting that ocular irritation, repeated mechanical trauma, and individual susceptibility contribute substantially to bacterial infection. Viral ocular inflammation was found to be more closely associated with factors related to disease transmission and direct contact. Eye rubbing and contact with individuals presenting similar symptoms represented the strongest risk factors (OR = 240.000 for both), while severe itchy eye and skin allergy (OR = 90.000 for both) were also significantly associated with viral inflammation. These findings suggest that direct transmission, close interpersonal contact, and behavioral factors play a crucial role in the spread and persistence of viral ocular infections. Similarly, allergic ocular inflammation showed strong associations with environmental allergens and clinical predisposition factors. Dust exposure represented the most important environmental risk factor (OR = 120.000), followed by exposure to animals (OR = 40.000) and pollen (OR = 30.000), confirming the major contribution of airborne allergens to disease onset. In addition, eye rubbing (OR = 165.000), mild itchy eye (OR = 390.000), and antihistamine use (OR = 390.000) showed very strong associations, while seasonal variation and family history further contributed to disease occurrence, indicating that allergic ocular II disease results from a complex interaction between environmental exposure, behavioral factors, and genetic predisposition. The analysis of oxidative stress and biological markers revealed significant diagnostic and predictive performance in ocular inflammatory diseases. In bacterial infections, plasma and tears MDA and GSH showed excellent diagnostic accuracy with high sensitivity (100%) and AUC values of 1.000, while protein, platelet, neutrophil, and basophil count also demonstrated perfect predictive performance (AUC = 1.000), suggesting that both oxidative stress imbalance and hematological changes play a major role in bacterial ocular inflammation. In contrast, SOD and catalase showed low or non-significant diagnostic value, indicating limited predictive relevance. In viral ocular inflammation, tears MDA (AUC = 0.960) and plasma MDA (AUC = 0.880) demonstrated strong predictive performance, alongside monocyte count (AUC = 0.960) and platelet count (AUC = 1.000), indicating that oxidative stress and immune cell alterations are closely involved in viral infection progression. Conversely, SOD, catalase, and several routine biochemical parameters showed weak or nonsignificant diagnostic value, suggesting limited utility as predictive biomarkers. In allergic ocular inflammation, most oxidative stress markers including plasma and tears MDA, GSH, catalase, and several hematological parameters demonstrated excellent predictive performance with AUC values reaching 1.000 in most cases. Monocyte count also showed strong diagnostic value (AUC = 0.980), indicating a major role of immune response activation and oxidative imbalance in allergic ocular disease pathophysiology. In conclusion, ocular inflammatory diseases are influenced by a combination of environmental, occupational, clinical, and immunological factors. In addition, oxidative stress and hematological alterations appear to play a central role in disease mechanisms and demonstrate strong diagnostic and predictive value, particularly MDA, GSH, platelet, and neutrophil-related parameters. These findings highlight the importance of early diagnosis, accurate differentiation between inflammatory types, and the use of oxidative stress biomarkers as potential tools for screening, monitoring, and therapeutic follow-up of ocular inflammatory diseases.