Characterization of Individuals with High-Frequency Artificial Tear Supplement Use

<b>Objectives</b>: We aimed to investigate dry eye parameters as potential predisposing factors and estimate the prevalence of high-frequency topical eye drop usage. <b>Methods</b>: A total of 5594 dry eye patients treated between November 2015 and June 2022 were included. High users (<i>n</i> = 180) were those who applied at least one artificial tear drop per hour, whereas those who used artificial tears fewer than four times daily were classified as low users (<i>n</i> = 5414). Differences in self-reported symptoms (OSDI, SPEED questionnaires) and tear-related parameters, including severity of corneal staining (SPK), fluorescein tear-film break-up time (FTBUT), lipid layer thickness (LLT), number of expressible meibomian glands (MGE), meiboscale, and blink patterns, were assessed. Subsequent follow-up comprehensive dry eye assessments were performed at 3 months. <b>Results</b>: There was no difference in age or sex between high users and low users (<i>p</i> = 0.075 and 0.508, respectively). High users had significantly higher symptom scores (<i>p</i> < 0.001), more total blinks (<i>p</i> = 0.001), lower Schirmer scores (<i>p</i> < 0.001), higher SPK grades (<i>p</i> < 0.001), shorter FTBUT (<i>p</i> = 0.010), and higher limbal redness scores (<i>p</i> = 0.002). However, there were no differences in the LLT, MGE, or meiboscale. The compliance with follow-up examinations at 3 months was significantly greater for the high users (<i>p</i> < 0.001). Patients with OSDI scores > 40, SPEED scores > 12, Schirmer scores ≤ 3 mm, and higher compliance with follow-up examinations had odds ratios of 4.0, 3.3, 1.7, and 4.1, respectively, for being high users (95% confidence intervals = 2.8-5.8, 2.4-4.7, 1.2-2.3 and 2.7-5.2, respectively). Among the high users, reducing topical drops significantly decreased the SPEED and OSDI scores, except for the environmental trigger factor in the OSDI questionnaire. During long-term follow-up, 1.1% of low users and 15.4% of high users received cyclosporine treatment (odds ratio 16.4, <i>p</i> < 0.001). <b>Conclusions</b>: OSDI scores > 40, SPEED scores > 12, and Schirmer scores ≤ 3 mm were associated with high-frequency eye drop usage, which accounted for 3.2% of moderate to severe dry eye patients. Susceptibility to environmental triggers could represent hyperalgesia/allodynia in high users. High users have a higher need for cyclosporine treatment.