Dry eye disease linked to immune diseases and chronic pain

1. In a sample of British women, one in ten reported having a diagnosis of dry eye disease, while one in five reported symptoms of dry eye disease in the past 3 months.

2. Dry eye disease was found to be associated with older age, immune-mediated diseases, and with chronic pain syndromes.

Evidence Rating Level: 3 (Average)

Study Rundown: Dry eye disease (DED) causes discomfort, visual problems, and may even cause long-term eye damage. Unfortunately, the etiology and risk factors for DED are not well known. This study surveyed a pre-established cohort of female twins in the U.K. to determine the prevalence and risk factors for DED. While 10% of women reported having the diagnosis of DED, approximately 20% of women reported having had symptoms of DED (e.g. foreign body sensation, itching, burning) in the past 3 months. Dry eye symptoms were more common in older women. DED was associated with cataract surgery, immune-mediated diseases (e.g. asthma, thyroid disease, and rheumatoid arthritis), and very strongly associated with chronic pain syndromes (e.g. irritable bowel syndrome, pelvic pain). A strength of this study is that it surveyed a cohort shown to be representative of the general UK population. Limitations of this study include that the diagnosis of DED was based on self-report and lack of information on simultaneous use of other medications. This study is the first U.K.-based population study of DED and adds to the literature by confirming previously identified risk factors including ophthalmic surgery and immune-mediated diseases. It also brings to light a new association with chronic pain syndromes, which may help elucidate the etiology of dry eye disease. Ophthalmology

Click to read the study, published in the British Journal of Ophthalmology

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In-Depth [cross sectional study]: This study surveyed 3,824 British women (age 20-87 years) within the TwinsUK adult registry to elucidate risk factors for DED. Participants were classified as a having DED if they answered “yes” to both having a diagnosis of dry eye disease made by a clinician and using treatment (artificial tears) for the disease. The prevalence of DED was found to be 9.6% (CI_95% 8.7%-10.6) while the prevalence of having DED symptoms in the past 3 months was 20.8% (CI_95% 19.5%- 22.1%). Symptoms were overall found to be more common in older women. The authors found no differences in the prevalence of DED between monozygotic and dizygotic twins. Risk factors were determined by using binary regression that controlled for age. Cataract surgery, immune-mediated diseases (asthma, allergies, thyroid problems, rheumatoid arthritis) and chronic pain syndromes (irritable bowel syndrome, pelvic pain, and chronic widespread pain syndrome or fibromyalgia) were significantly associated with DED. Additional identified risk factors included fertility problems, migraines, and depression. DED was also associated with lower self-perceived health status in a random subsample of 681 participants.

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Image: PD

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