Dry eye disease and psychiatric disorders: A systematic review and meta-analysis

Abstract

The association between dry eye disease (DED) and psychiatric conditions is a highly researched topic. This work reviews the literature on this relationship, examining the prevalence and correlations of depression and anxiety with dry eye signs and symptoms. A comprehensive literature search of MEDLINE, EMBASE, PsycINFO, and gray literature was conducted, with keywords for dry eye and mood disorders, depression, anxiety, and suicide. Eligible studies underwent quality assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using STATA 15.0. Fixed- and random-effects models were computed based on the presence of heterogeneity. Thirty-two studies were included, with 31 reporting on depression and 19 on anxiety. Meta-analysis results found a depression prevalence of 40% (CI: [0.29, 0.52]) in DED patients, with 1.81 times higher odds of prevalence compared to controls (CI: [1.61, 2.02]). Prevalence of anxiety was 39% (CI: [0.15, 0.64]), with 2.32 times higher odds of prevalence compared to controls (CI: [1.67, 3.23]). Depression scores were significantly higher in patients with DED in all studies. Anxiety scores were significantly higher in DED patients in studies using all scales except the Hospital Anxiety and Depression Scale-Anxiety Subscale. DED symptom scores were significantly associated with depression (ES = 0.43; CI: [0.31, 0.55]) and anxiety (ES = 0.41; CI: [0.32, 0.50]) scores. In conclusion, depression and anxiety are more prevalent and severe in DED patients and are correlated with dry eye symptoms but not signs. These findings highlight the interrelationship between these disorders and have important implications for providing appropriate care to these patients.

The prevalence of anxiety symptoms and disorders among ophthalmic disease patients

“… 101 It is notable that in 2017, a meta-analysis performed by Wan et al 68 indicates that DED is associated with nearly a three times increase in the prevalence of anxiety. Recently, Basilious et al 102 indicated possible interrelationships between DED severity with anxiety symptoms. In agreement with this finding, Zhang et al 42 demonstrated that glaucoma patients exhibit a 10-fold increase in the risk of developing anxiety disorders.…”

Association between dry eye disease and depression: An umbrella review

“…These five studies were published between 2016 and 2021. Two of the studies defined the outcome as primary Sjogren's syndrome-related dry eye disease ( 27 , 30 ), other two simply as dry eye disease ( 29 , 31 ), and in one study, a subgroup analysis was performed and both Sjogren's syndrome- and non-Sjogren's syndrome-related dry eye disease were included in the outcomes ( 28 ). Based on the criteria and the characteristics of each included study, we classified our included studies into several groups.…”

Correlation of depression, anxiety and stress level on dry eye disease severity

“…The study conducted in the United States on adults over 18 years found the prevalence of DED in the age range 18-34 years by 2.7% and increased at the age above 75 years, which is 18.6%. Dry eyes are more common at the age above 40 years where at this age there is a decrease in tear secretion, lacrimal gland instability, an increase in the prevalence of abnormalities in the meibomian glands, and an increase in the likelihood of developing diseases that attack the elderly such as diabetes mellitus, hypertension, hypercholesterolemia (Bron et al, 2014;Farrand et al, 2017;Basilious, Xu and Malvankar-Mehta, 2022) Chronic diseases such as diabetes mellitus, cholesterol, a history of allergies, and hypertension are among the comorbidities that elderly patients often experience. In this study, 20 patients (21.5%) had a history of DM and 73 (78.5%).…”

“…Wan KH et al in 2016 found that the prevalence of depression and anxiety in DED patients was three times higher than in patients without DED and population found an increase in DED in 472 psychiatric patients suffering from depression and anxiety. Basilious, Xu, and Malvankar-Mehta, (2022) found an association between DED and post-traumatic stress disorder (PTSD) in a veteran population. Vaart et al (2015) found that the odds ratio of DED to Depression was 2.9 (95% CI 2.7-3.1), and the odds ratio of DED to Anxiety was 2.8 (95% CI 2.6-3.0).…”

“…Wen et al, 2012 observed an increase in the frequency of DED in 472 psychiatric patients treated with various psychiatric disorders, including depression and anxiety 60% (Wan, Chen and Young, 2016). There is a relationship between DED and post-traumatic stress, but these data are only carried out in specific populations such as old age (Basilious, Xu and Malvankar-Mehta, 2022). Patients with DED tend to experience more symptoms of Anxiety than people in general (Stevenson, Chauhan and Dana, 2012).…”