Purpose: The association between dry eye disease (DED) and mood disorders is a highly researched topic, with many new studies being conducted each year. Previous research has reported a greater prevalence of depression and anxiety among DED patients, as well as depression as a risk factor for dry eye. This work seeks to review the most current literature on the relationship between these disorders, as well as further examine how depression and anxiety relate specifically to dry eye signs as compared to symptoms.

Study design: Systematic review and meta-analysis

Methods: A comprehensive literature search of MEDLINE, EMBASE, and PsycINFO was conducted using the Ovid platform, and a grey literature search was also performed. These searches included keywords for dry eye and mood disorders, depression, anxiety, and suicide. Studies were screened by two independent reviewers. All eligible studies with full-text articles underwent quality assessment using the Newcastle-Ottawa Scale. After data extraction, meta-analysis was performed using STATA 15.0. Fixed- and random-effects models were computed based on presence of heterogeneity.

Results: Thirty-one studies were included in this review, with 30 studies reporting on depression and 15 of these studies reporting on anxiety. Meta-analysis results indicated significant odds of depression prevalence among DED patients (OR = 1.72, CI:[1.53, 1.93]). Depression scores were significantly correlated with dry eye symptom severity in 8 of 11 studies. The opposite trend was found for dry eye signs, with all of 10 studies reporting no significant correlation of depression scores with tear break-up time (TBUT) and 9 of 10 studies reporting no significant correlation with Schirmer’s test or corneal fluorescein staining. Anxiety scores were significantly correlated with dry eye symptom severity in 7 of 9 studies. For dry eye signs, 8 of 9 studies reported no significant correlation to tear break-up time (TBUT), Schirmer’s test or corneal fluorescein staining. 

Conclusions: Depression is more prevalent in patients with DED and was found to be correlated with dry eye symptoms but not signs in most studies. These findings highlight the interrelationship between DED and mood-related disorders and indicate that depression may modulate how patients with DED present. This has important implications for providing appropriate care to patients with DED.

The association of dry eye disease with depression and anxiety: A systematic review and meta-analysis

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