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Ophthalmology. 2021 Mar 27:S0161-6420(21)00235-9. doi: 10.1016/j.ophtha.2021.03.030. Online ahead of print.


OBJECTIVE: Certain systemic conditions are reported to be risk factors for dry eye disease (DED), but their associations with DED severity are not well-studied. We evaluated whether systemic conditions reported to be DED risk factors are associated with severity of DED signs and symptoms.

DESIGN: Secondary analysis of data from the DREAM Study, a large-scale multi-center randomized clinical trial of patients with moderate-to-severe DED.

SUBJECTS: 535 adult patients with moderate-to-severe DED from 27 US centers.

METHODS: Patients reported their medical history at baseline. They underwent ocular surface exams and symptom evaluation using standardized protocols at baseline, 6 months, and 12 months. We analyzed the associations of systemic conditions (a systemic disease or smoking history) reported as potential DED risk factors with the severity of DED signs and symptoms using generalized linear regression models adjusted by age, sex, race, and visit. To be included, conditions had at least 25 patients.

MAIN OUTCOME MEASURES: DED symptoms assessed using the Ocular Surface Disease Index (OSDI), six DED signs (tear break-up time, anesthetized Schirmer testing, corneal fluorescein staining, conjunctival lissamine green staining, tear osmolarity, and meibomian gland dysfunction), and a composite signs severity score with range 0-1 (1 most severe) calculated from the six DED signs.

RESULTS: The mean±SD age was 58±13.2 years, and 81% were female. More severe DED signs were significantly associated with Sjögren's syndrome (mean±SD of composite signs severity score: 0.52±0.17 with disease vs. 0.43±0.13 without disease, p<0.001), facial rosacea (0.47±0.13 vs. 0.43±0.13, p=0.002), rheumatoid arthritis (0.47±0.14 vs. 0.42±0.12, p=0.002), peripheral artery disease (0.50±0.14 vs. 0.43±0.13, p<0.001), and daily smoking history (0.45±0.13 vs. 0.43±0.13, p=0.047). Thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, and hypertriglyceridemia were not significantly associated with DED signs. No conditions were significantly associated with OSDI.

CONCLUSION: In this large, well-characterized cohort of DED patients assessed under standardized procedures, patients with certain systemic diseases and smoking had more severe DED signs compared to patients without the condition. The profile of significant DED signs varied by systemic condition, reflecting different DED etiologies. Understanding the systemic conditions and underlying etiologies that predispose some patients to severe DED can improve management.

PMID:33785415 | DOI:10.1016/j.ophtha.2021.03.030

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