Systemic Diseases, Smoking Associated With More Severe Dry Eye

Tired woman with eyes inflammation is looking into the mirror
Researchers say identifying patients predisposed to the ocular surface disease can help guide treatment.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of The Association for Research in Vision and Ophthalmology (ARVO), held virtually from May 1 to 7, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the eye and vision experts at ARVO. Check back for more from the ARVO 2021 Meeting.


Sjögren’s syndrome, facial rosacea, rheumatoid arthritis, peripheral artery disease, and daily smoking history were significantly associated with more severe dry eye disease (DED) signs in a large cohort, according to a poster presented at the Association for Research in Vision and Ophthalmology (ARVO) 2021 Annual Meeting, held virtually May 1 to May 7.

Results from a secondary analysis of the Dry Eye Assessment and Management (DREAM) Study—a large-scale multicenter randomized clinical trial of patients with moderate-to-severe DED—demonstrate that the knowledge of certain systemic conditions and underlying etiologies could potentially help in severe DED management, investigators report. 

This cohort’s data was designed to examine those systemic conditions that are associated with severity of dry eye signs and symptoms but have not been studied extensively. It looked at 535 patients (mean age 58±13.2 years, 81% women) with moderate-to-severe DED at 27 centers in the US. They were assessed for DED symptoms at baseline, 6 months, and 12 months with the Ocular Surface Disease Index (OSDI) and for 6 DED signs: tear break-up time, Schirmer’s test with anesthesia, corneal staining, conjunctival staining, tear osmolarity, and meibomian gland dysfunction. A composite signs severity score, ranging from 0 to 1 (1 being most severe) was calculated from the six DED signs. Researchers analyzed associations of systemic conditions with DED signs and symptoms severity using generalized linear regression models adjusted by age, sex, race, and visit. Conditions had to have at least 25 patients for inclusion. 

Investigators found that more severe DED signs were significantly associated with Sjögren’s syndrome (composite mean: 0.52±0.17 with disease vs 0.43±0.13 without disease, P <.001), facial rosacea (0.47±0.13 vs 0.43±0.13, P =.002), rheumatoid arthritis (0.47±0.14 vs 0.42±0.12, P =.002), peripheral artery disease (0.50±0.14 vs 0.43±0.13, P <.001), and daily smoking history (0.45±0.13 vs 0.43±0.13, P =.047). 

Researchers say they were not able to associate severe DED signs with thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, or hypertriglyceridemia. 

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Bunya VY, Maguire MG, Ying G, et al. Systemic conditions associated with the severity of dry eye signs and symptoms in the Dry Eye Assessment and Management (DREAM) Study. Poster presented at: The Association for Research in Vision and Ophthalmology (ARVO) 2021 Annual Meeting; May 1-7; Virtual. Abstract 3500328.