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Meta-Analysis
. 2022 Jul;32(4):1872-1889.
doi: 10.1177/11206721211060963. Epub 2021 Dec 22.

Dry eye disease and psychiatric disorders: A systematic review and meta-analysis

Amy Basilious  1 , Cathy Y Xu  1 , Monali S Malvankar-Mehta  2   3
Affiliations
Meta-Analysis

Dry eye disease and psychiatric disorders: A systematic review and meta-analysis

Amy Basilious et al. Eur J Ophthalmol. 2022 Jul.

Abstract

The association between dry eye disease (DED) and psychiatric conditions is a highly researched topic. This work reviews the literature on this relationship, examining the prevalence and correlations of depression and anxiety with dry eye signs and symptoms. A comprehensive literature search of MEDLINE, EMBASE, PsycINFO, and gray literature was conducted, with keywords for dry eye and mood disorders, depression, anxiety, and suicide. Eligible studies underwent quality assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using STATA 15.0. Fixed- and random-effects models were computed based on the presence of heterogeneity. Thirty-two studies were included, with 31 reporting on depression and 19 on anxiety. Meta-analysis results found a depression prevalence of 40% (CI: [0.29, 0.52]) in DED patients, with 1.81 times higher odds of prevalence compared to controls (CI: [1.61, 2.02]). Prevalence of anxiety was 39% (CI: [0.15, 0.64]), with 2.32 times higher odds of prevalence compared to controls (CI: [1.67, 3.23]). Depression scores were significantly higher in patients with DED in all studies. Anxiety scores were significantly higher in DED patients in studies using all scales except the Hospital Anxiety and Depression Scale-Anxiety Subscale. DED symptom scores were significantly associated with depression (ES = 0.43; CI: [0.31, 0.55]) and anxiety (ES = 0.41; CI: [0.32, 0.50]) scores. In conclusion, depression and anxiety are more prevalent and severe in DED patients and are correlated with dry eye symptoms but not signs. These findings highlight the interrelationship between these disorders and have important implications for providing appropriate care to these patients.

Keywords: Dry eye; anxiety; depression; dry eye disease.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA diagram illustrating search strategy and study selection.
Figure 2.
Figure 2.
Funnel plots including studies reporting (A) Depression prevalence in dry eye disease (DED), (B) Prevalence of depression in DED compared to controls, (C) Anxiety prevalence in DED, (D) Anxiety prevalence in DED compared to controls, (E) Depression scale score in DED compared to controls, (F) Anxiety scale scores in DED compared to controls. Dashed lines indicate the 95% confidence intervals.
Figure 3.
Figure 3.
Forest plot for the prevalence of depression in dry eye disease (DED) patients.
Figure 4.
Figure 4.
Forest plot for the odds ratio (OR) of depression prevalence in dry eye disease (DED) patients compared to controls. A positive OR of depression prevalence indicates that DED patients have a higher prevalence of depression compared to controls.
Figure 5.
Figure 5.
Forest plot for the prevalence of anxiety in dry eye disease (DED) patients.
Figure 6.
Figure 6.
Forest plot for the odds ratio (OR) of anxiety prevalence in dry eye disease (DED) patients compared to controls. A positive OR of anxiety prevalence indicates that DED patients have a higher prevalence of anxiety compared to controls.
Figure 7.
Figure 7.
Forest plot for the standard mean difference (SMD) of depression scale score in dry eye disease (DED) patients compared to controls. Positive SMD indicates that DED patients have higher depression scores compared to controls.
Figure 8.
Figure 8.
Forest plot for the standard mean difference (SMD) of anxiety scale score in dry eye disease (DED) patients compared to controls. A positive SMD indicates that DED patients have higher anxiety scores compared to controls.
Figure 9.
Figure 9.
Forest plot for the correlation between depression scale scores and dry eye symptom scores.
Figure 10.
Figure 10.
Forest plot for the correlation between anxiety scale scores and dry eye symptom scores.
See this image and copyright information in PMC

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