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The Correlation Between Dry Eyes, Anxiety and Depression

The Sicca, Anxiety and Depression Study

Bitar, Maya S. MD*; Olson, Daniel J. MD; Li, Menbing MS; Davis, Richard M. MD

doi: 10.1097/ICO.0000000000001932
Clinical Science

Purpose: To determine whether improvement in the severity of dry eye disease (DED) symptoms correlates with improvement in anxiety and depression.

Methods: This prospective interventional case series recruited 45 adults with evidence of DED. Patients were administered the University of North Carolina Dry Eye Management Scale (DEMS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Personal Health Questionnaire Depression Scale (PHQ-8) to evaluate the severity of DED symptoms, anxiety, and depression, respectively. Standard of care treatment was provided for patients for 3 to 6 months, followed by re-administration of the DEMS, GAD-7, and PHQ-9 surveys. Statistical analysis was performed to assess the relationships between changes in survey scores.

Results: Participants had a mean age of 65.5 (SD, 13.3) years, and 37 (84.6%) were women. Seven patients were lost to follow-up. DEMS and GAD-7 significantly improved from 5.8 ± 1.8 to 4.6 ± 0.2.2 (P = 0.01) and from 5.6 ± 5.5 to 3.3 ± 4.6 (P = 0.05), respectively. Changes in DEMS correlated with changes in PHQ-8 (ρ = 0.3 P = 0.05), but not with changes in GAD-7 (ρ = 0.2 P = 0.3). Changes in DEMS correlated with changes in both PHQ-8 and GAD-7 in the subgroup of patients without prior depression or anxiety diagnosis (ρ = 0.6, P = 0.002; ρ = 0.4, P = 0.02). A multivariate analysis showed that the relationship between DEMS, PHQ-8, and GAD-7 was independent of a prior diagnosis of depression or anxiety and of the presence of comorbidities.

Conclusions: There is a significant correlation between the severity of DED and symptoms of depression and anxiety. Effective DED treatment could have a positive impact on the symptoms of depression and anxiety.

*Department of Ophthalmology, Marshall University, Huntington, WV;

Department of Ophthalmology, University of North Carolina, Chapel Hill, NC; and

Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.

Correspondence: Maya S. Bitar, MD, Department of Ophthalmology, Marshall University, 5187 US Route 60 E, Suite 6. Huntington WV 25705 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received May 21, 2018

Received in revised form January 28, 2019

Accepted February 08, 2019

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