A cross-sectional analysis of the associations between dry eye disease and depression

Abstract Dry Eye Disease (DED) is a common condition worldwide that is often associated with mental health conditions such as depression. The study evaluates the associations between dry eye disease and depression in the Hong Kong population, based on a large population-based cohort. A total of 614 participants were enrolled, and 1228 eyes were evaluated. The Ocular Surface Disease Index (OSDI) questionnaire was administered to assess subjective dry eye symptoms. Lipid layer thickness (LLT) was measured using the IDRA ocular surface analyzer, while tear meniscus height (TMH), first non-invasive tear break-up time (NITBUT), average NITBUT, Meiboscore, and redness were assessed with the Keratograph 5 M. The osmolarity was measured by the TearLab. Dry eye and non-dry eye were categorized based on the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) diagnostic criteria. Depression classification was based on participant self-report, together with concurrent antidepressant use. For statistical analysis, the Kolmogorov–Smirnov test was used to examine normality. Fisher’s exact test was applied to categorical variables, and the Mann–Whitney U test was used for continuous variables in two-group comparisons. A Generalized Estimating Equation (GEE) model was constructed to explore associations between dry eye parameters and depression. Among the 614 participants recruited from the general Hong Kong population, 596 were classified as not having depression (1192 eyes; median age, 46 years), and 18 were classified as having depression (36 eyes; median age, 51 years). The OSDI score was higher among participants with depression than among participants without depression [20 (9–36) vs. 14 (6–23), P = 0.004]. However, other parameters showed no significant differences between the two groups. In the multivariate model, the OSDI score was significantly associated with depression, showing an odds ratio (OR) of 1.03 (95% CI: 1.01–1.06; P = 0.015). Furthermore, the severe subjective dry eye (OSDI > 32) was significantly associated with depression, with an OR of 3.00 (95% CI: 1.14–7.86; P = 0.026). Severe DED symptom score was significantly associated with depression in the population of Hong Kong, highlighting the clinical relevance of the relationship between DED and mental health.