Systemic diseases, smoking history linked to more severe dry eye signs

Certain systemic diseases, such as Sjögren syndrome (SS), facial rosacea, rheumatoid arthritis (RA), and peripheral artery disease, and a history of daily cigarette smoking are significantly associated with more severe dry eye disease (DED) signs, a study has found.

“Furthermore, the profile of significant dry eye signs varied by systemic condition, reflecting different dry eye causes,” the researchers said. “Understanding the systemic conditions and underlying causes that predispose certain patients to more severe DED, compared with patients without these systemic conditions, can improve management.”

This secondary analysis of data from the Dry Eye Assessment and Management Study included 535 adult patients (mean age 58 years, 81 percent women) with moderate-to-severe DED from 27 centres in the US. Patients reported their medical history at baseline and underwent ocular surface examination and symptom evaluation using standardized protocols at baseline, 6 months, and 12 months.

The researchers then analysed the relationship of systemic conditions (a systemic disease or smoking history) reported as potential DED risk factors with the severity of DED signs and symptoms using generalized linear regression models, adjusting for age, gender, race, and visit.

More severe DED signs were found to significantly correlate with SS (mean composite signs severity score 0.52 with disease vs 0.43 without disease; p<0.001), facial rosacea (0.47 vs 0.43; p=0.001), RA (0.47 vs 0.42; p=0.001), peripheral artery disease (0.50 vs 0.43; p<0.001), and daily smoking history (0.45 vs 0.43; p=0.047). [Ophthalmology 2021;128:1384-1392]

On the other hand, DED signs were not significantly associated with thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolaemia, hypertension, and hypertriglyceridaemia. Moreover, no conditions significantly correlated with Ocular Surface Disease Index (OSDI).

Of note, older age also did not correlate with higher OSDI score, despite its association with more severe dry eye signs.

This finding is consistent with that of other studies, which identified age as predictive of discordance between dry eye signs and symptoms, potentially due to the reduced corneal sensitivity in older adults. [Ophthalmology 2017;124:280-286; Br J Ophthalmol 2018;102:674-679; Ophthalmic Physiol Opt 2012;32:518-526; Invest Ophthalmol Vis Sci 2016;57:617-625]

“Although various studies have suggested that certain systemic diseases are risk factors for the development of dry eye, few other studies have identified whether these systemic diseases are associated significantly with the severity of dry eye as measured by ocular surface examinations and symptom indices,” the researchers said.

The current study is limited by the possible underestimation of the association between certain systemic conditions and DED severity due to potential bias from coexisting systemic diseases and a study population limited to patients with moderate-to-severe DED.

Other limitations are as follows: the use of patient’s self-report to determine the presence or absence of systemic disease without differentiating severity and duration, as well as possible confounding by multiple testing of 12 systemic conditions and seven DED signs and symptoms.