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Cornea. 2019 Jun;38(6):684-689. doi: 10.1097/ICO.0000000000001932.

The Correlation Between Dry Eyes, Anxiety and Depression: The Sicca, Anxiety and Depression Study.

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Department of Ophthalmology, Marshall University, Huntington, WV.
Department of Ophthalmology, University of North Carolina, Chapel Hill, NC.
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.



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


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.


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.


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.

[Indexed for MEDLINE]

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