Alcohol consumption may be a risk factor for dry eye disease (DED) in women but not in men, according to findings published in Ocular Surface.

Researchers conducted a population-based study to assess the association between DED and alcohol consumption, concluding that there is a clear sex-specific effect in females. The study, which cross-sectionally assessed participants of the Dutch Lifelines cohort for DED, used logistic regression and corrected for 55 confounding comorbidities, as well as demographic information. The participants (n=77,145) were between the ages of 19 and 94 years and completed the Women’s Health Study (WHS) dry eye questionnaire for the present study. 

The study found that, of the 30% of participants with symptomatic DED, the risk was significantly increased in women (95% CI, 1.045-1.148), but not in men (95%CI, 0.9-1.084). Additionally, the increase of alcohol intake had a protective effect on DED in men (95%CI, 0.934-.0992) but not in women (95% CI, 0.950-1.023). For all outcomes assessed, including symptomatic dry eye, highly symptomatic dry eye, clinical diagnosis, and WHS definition dry eye, alcohol intake had a sex-specific effect.


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The researchers note that these results are consistent with those of previous research, illustrating the importance of sex stratification in DED studies. Also, they explain possible reasons for the protective effect alcohol has been shown to have on DED, including differences in sex hormones and the increased androgens present in males.

“Studies have suggested that androgen deficiency can cause an auto-immune process leading to tear deficiency, corneal and conjunctival damage, lacrimal gland inflammation, and meibomian gland dysfunction,” the researchers note. “This is supported by recent findings showing that the anti-androgen finasteride disrupts the ocular homeostasis and induces dry eye.”

Regarding the protective effect of alcohol on DED, which was present in males and older females, the study explains that higher cumulative exposure to alcohol could be relevant.

“One possible mechanism for this finding might be that alcohol-induced peripheral neuropathy leads to a decreased corneal sensitivity and, thus, fewer symptoms,” the report says. 

Study strengths included large sample size and the use of validated questionnaires for assessing both alcohol consumption and dry eye. The researchers note limitations, including the fact that, in about 30% of participants, only past data on alcohol consumption was available for inclusion, and also, that the self-reported nature of the data may have had a confounding effect.

Reference

Magno MS, Daniel T, Morthen MK, et al. The relationship between alcohol consumption and dry eye. Ocul Surf. 2021;21(7):87-95. doi:10.1016/j.jtos.2021.05.005.