Patients with both dry eye and depression may be subject to worse ocular symptoms.
Patients with both dry eye and depression may be subject to worse ocular symptoms. Photo: Candice Tolud, OD. Click image to enlarge.

While evidence suggests depression is more prevalent among patients with DED compared with those without the condition, a team of researchers sought to better understand the connection between depression and the severity of dry eye signs and symptoms. They conducted a secondary, cross-sectional, longitudinal analysis using data from the Dry Eye Assessment and Management (DREAM) study.

A multicenter, randomized clinical trial, the DREAM study, included 535 patients from 27 ophthalmology and optometry centers across 17 states. A score of 42 or less on the Mental Component Summary (MCS) of the 36-Item Short Form Health Survey indicated depression among the enrolled patients.

The researchers assessed symptoms of DED using the Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI). Signs in each eye were evaluated by tear film breakup time, Schirmer test, corneal and conjunctival staining, tear osmolarity and meibomian gland dysfunction at baseline, six months and 12 months. The researchers used all six measurements to calculate a composite severity score.

Data revealed that participants who screened positive for depression had worse DED symptoms according to the OSDI, BODI and composite DED score. The study authors reported that worse depression—or a lower MCS score—was associated with a higher OSDI score at baseline, six months and 12 months. They also found that inflammatory markers did not differ based on depression status.

“Symptoms and overall signs of DED were more severe in participants with moderate to severe DED who screened positive for depression, suggesting depression may be associated with more severe DED,” the study authors noted. “Identifying depression and considering treatment, including systemic medications, may be useful in managing patients with DED. Patients with more severe DED concerns or sign measurements may benefit from comorbid psychiatric screening.”

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. March 10, 2022. [Epub ahead of print].