Purpose To investigate the association between dry eye disease and each of depression and anxiety. Design Retrospective, case-control study Methods Setting University of North Carolina outpatient clinics Study Population All patients over the age of 18 years old seen between July of 2008 and June of 2013 were included in the analysis. Observation Procedure Cases were defined according to ICD-9 diagnosis codes for dry eye disease, anxiety, and depression. Outcome Measure Separate odds ratios were calculated for dry eye disease and each of anxiety and depression. Similar odds ratios were also calculated between dry eye disease and rheumatoid arthritis, a systemic disease with a known association with dry eye, as a way of validating our approach. Results A total of 460,611 patients were screened; 7,207 patients with dry eye were included, while 20,004 patients with anxiety and 30,100 patients with depression were included. The adjusted odds ratio for dry eye disease and anxiety was 2.8 (95% CI 2.6–3.0). For dry eye disease and depression, the odds ratio was 2.9 (95% CI 2.7–3.1). Conclusions We identified a statistically significant association between dry eye disease and each of depression and anxiety. Such an association has implications for ophthalmologists in the management and treatment of dry eye disease.

Purpose Dry eye disease (DED) is a common ocular disease that can have adverse effects on quality of life. Our aim was to develop a single-item questionnaire that is reliable, patient-driven, and clinic-friendly to assess DED symptoms and their effect on quality of life in order to help support the management of patients with DED. Methods An initial dry eye questionnaire was created and administered to 18 patients with DED followed by a 15-minute cognitive interviewing session. This questionnaire was then refined using feedback obtained from the cognitive interview and was termed the University of North Carolina Dry Eye Management Scale (UNC DEMS). Field testing was then performed on 66 patients (46 with DED and 20 without DED) to determine the validity and test re-test reliability of the UNC DEMS compared to the current gold standard, the Ocular Surface Disease Index (OSDI). Pearson correlation coefficients were calculated between the UNC DEMS, OSDI, and other DED measures to assess criterion-related validity. Reliability coefficients were estimated for test-retest reliability. Results Comparing the UNC DEMS to the OSDI across all study participants, the correlation coefficient was 0.80 (p < 0.001). Comparing the UNC DEMS to the OSDI in the DED group, the correlation coefficient was 0.69 (p < 0.001). The test-retest reliability coefficient of the UNC DEMS was estimated to be 0.90. Conclusion The UNC DEMS is a valid, reliable questionnaire that can be efficiently administered in a busy clinical practice and can be used to support the management of patients with DED.