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  • Cornea/External Disease

    Review of: Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study

    Zhou Y, Murrough J, Yu Y, et al. JAMA Ophthalmology, April 2022

    This study analyzed data from the Dry Eye Assessment and Management (DREAM) study to examine the relationship of dry eye disease severity with depression, which was assessed through a patient survey, the Medical Outcomes study, and a 36-item short form health survey that assesses both physical and mental well-being.

    Study design

    This study performed secondary cross-sectional and longitudinal analyses of data from the Dry Eye Assessment and Management (DREAM) study, a randomized clinical trial evaluating fatty acids for dry eye disease. The study evaluated an association between depression, as measured by a health survey, and dry eye, as measured by symptoms, signs, and inflammatory markers.


    When looking at results from all time points combined, the study showed that: 1) Participants who screened positive for depression had a higher mean ocular surface disease index (OSDI) score compared with those who screened negative for depression; higher OSDI scores indicate more severe dry eye disease symptoms; 2) Participants who screened positive for depression had a higher mean severity score for signs of dry eye disease compared with those who screened negative; 3) There was no difference in human leukocyte antigen–DR isotype (HLA–DR) percentages or in tear cytokines between those who screened positive and those who screened negative for depression.


    A limitation of the study is the use of a questionnaire to assess for depression, which may result in misclassification for the disease. Tear cytokine analysis was also limited due to patients who were able to provide sufficient tear samples, being younger and with less severe dry eye disease.

    Clinical significance

    Consideration should be kept in mind that patients with moderate and severe dry eye disease may have depression. Ophthalmologists may be able to assist patients by referring them for appropriate psychiatric evaluation when a diagnosis has not yet been made. Additionally, treatment of their depression may be useful in treating dry eye in these patients. Further work is needed to understand the mechanism for the association between dry eye and depression.