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Is there an association between Depression and Dry Eye Disease Severity?

Title Article: Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study

What are the key takeaway points?

Dry Eye Disease (DED) is a common inflammatory condition affecting millions of people worldwide. It is characterized by irritative ocular pain resulting in both discomfort and vision changes that can greatly impact quality of life. Depression is more prevalent among patients with DED and both diseases have pathogenic associations with inflammation. However, the relationship and underlying inflammatory mechanisms are not well understood. The objective of this study was to investigate the association between depression and severity of DED symptoms.

Secondary analysis of a 12-month, multi-centre randomized control trial known as the Dry Eye Assessment and Management (DREAM) study was performed. Severity of DED symptoms were evaluated through the Ocular Surface Disease Index (OSDI), the Brief Ocular Discomfort Inventory (BODI), and a combined score of 6 DED signs (Tear Film Breakup Time (TBUT), Schirmer test, corneal staining, conjunctival staining, tear osmolarity, and meibomian gland dysfunction). Depression was evaluated through a Mental Component Summary (MCS) score, self-reporting, and the use of antidepressant medications. Various inflammatory markers were measured from tear samples.

Overall, the study found that among participants with moderate to severe DED, those who screened positive for depression had worse DED signs and symptoms compared to those who screened negative.

A low MCS score (indicative of depression) was not correlated with any of the 6 DED signs. However, a high MCS score (good mental health standing) was associated with an improvement in tear osmolarity and the Schirmer test. Although there was observed association between severity of DED and depression, there was no clear evidence to support inflammatory markers as a part of this association. The researchers hypothesized that the association between DED and depression may be due to the impact DED has on quality of life, increasing one’s susceptibility to depression, or that depression may lead to increased screen time which can contribute to DED. Another theory is that depression may be associated with changes in pain sensitization or somatic manifestations of DED. Though the above association needs to be further investigated, identifying depression and considering treatment may be useful in managing patients with severe DED.

Publication date: April 2022


Zhou Y, Murrough J, Yu Y, Roy N, Sayegh R, Asbell P, Maguire MG, Ying GS; DREAM Study Research Group. Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study. JAMA Ophthalmol. 2022 Apr 1;140(4):392-399. doi: 10.1001/jamaophthalmol.2022.0140. PMID: 35266971; PMCID: PMC8914873.

Summary by: Hasan Khan


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