An estimated 16 million Americans have been diagnosed with Dry Eye Disease (DED) but the actual number suffering from dry eye symptoms is likely much higher, with many treating symptoms using over-the-counter remedies. When you consider the symptoms of DED, such as burning or stinging, light sensitivity, blurred vision and gritty sensation, it’s understandable that the chronic discomfort can affect quality of life and mood. A recent study shows that the connection between DED and depression may actually be quite common. (Zhou Y, Murrough J, Yu Y, et al. Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study. JAMA Ophthalmol. 2022;140(4):392–399. doi:10.1001/jamaophthalmol.2022.0140)
Researchers analyzed data from the Dry Eye Assessment and Management (DREAM) study and screened patients for depression using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). They found that participants who screened positive for depression had worse DED symptoms than participants who screened negative for depression. The research suggests that patients with DED may be more at risk for depression through decreased quality of life, shared genetic factors, changes to central pain processing and the effects of antidepressant medications. Inflammation has also been implicated in the development of both DED and depression, but little is known about whether the same inflammatory processes affect both conditions.
The chicken-or-the egg question remains, however. People suffering from depression are more likely to spend more time watching TV and using a computer, and increased screen time may contribute to DED. Sleep disturbances are associated with depression, and lack of sleep can exacerbate dry eye. What’s more, some antidepressant medications can interfere with natural tear film production. On the other hand, DED affects quality of life, leading to depression. For one thing, pain and chronic discomfort from DED can worsen symptoms of depression, and then the resulting depression worsens feelings of pain. Blurred vision and glare interfere with many visual tasks such as driving or reading, and negatively impact thinking, learning, memory and concentration. That in turn can affect workplace performance and productivity. Symptoms of DED can limit participation in sports, recreation and leisure activities. Even the appearance of eye redness from DED can negatively influence emotional health.
Researchers agree that there’s a connection between DED and depression, and both can happen at the same time. More study is needed to determine the physical link and whether one initiates the other, but it’s important for ECPs to be aware of the emotional toll of DED and recommend appropriate care.
• Linda Conlin
Pro to Pro Managing Editor