Review Shows Impact of Age, Sex on Dry Eye

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A study of 3 groups evaluated potential demographic factors using a variety of tests.

Female patients and those in older age groups experience the signs and symptoms of dry eye disease (DED) more strongly, according to findings published in The Ocular Surface. 

In a clinic-based study conducted at the Norwegian Dry Eye Clinic from 2012 to 2018, 1823 patients diagnosed with dry eye disease (DED) were examined on several criteria to determine if sex and age have an effect on their symptoms. The examinations included tear osmolarity, tear break-up time (TFBUT), ocular surface staining, corneal sensitivity, Schirmer I test, meibum expressibility (ME), meibum quality (MQ), and having patients respond to the ocular surface disease index (OSDI) questionnaire,

The researchers analyzed the data and found females showed increased osmolarity, shorter TFBUT, reduced MQ and ME and higher corneal sensitivity.

“Dry eye disease (DED) is ‘a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles,’” the study explains.

To look at effects on age, the study included 3 subgroups of patients from ages 20 to 39, 40 to 59 and 60 years or older. The study associated increasing age with the effects of DED. The study shows significantly higher OSDI, lower TFBUT, lower Schirmer I test, and worse ME in the older groups. Both sex and age had an effect on all parameters examined for this study, but only TFBUT and ME were influenced by both variables (P <.05). 

The study also found a positive correlation between signs of DED and meibomian gland dysfunction (MGD) as well as increased tear film evaporation in female participants in the advanced age groups.

When assessing meibum quality and expressibility, the researchers only used the lower eyelid. Discrepancies have been shown between the upper and lower eyelids wherein a greater expression of meibum exists in the upper eyelid. This limitation may have had an effect on results; however, a major strength of the study was its large sample size and assessment of such a range of clinical parameters.

Prior research demonstrates that more females experience DED than males due primarily to sex hormones. The fact that androgen levels are typically lower in females may provide an explanation for reduced ME and MQ among females in this research, the investigators speculate.


Tellefsen S, Badian RA, Utheim TP, et al., Sex and age differences in symptoms and signs of dry eye disease in a Norwegian cohort of patients.The Ocular Surface. 2021;19(1):68-73. doi:10.1016/j.jtos.2020.11.009.