Systemic, environmental and lifestyle risk factors for dry eye disease in a mediterranean caucasian population

José Vicente García-Marqués, Cristian Talens-Estarelles, Santiago García-Lázaro, James S. Wolffsohn, Alejandro Cerviño*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: To assess systemic, environmental and lifestyle risk factors for dry eye disease (DED) in a Mediterranean Caucasian population. Methods: A cross-sectional study was performed on 120 Caucasian participants aged between 18 and 89 years (47.0 ± 22.8 years). Medical history, information regarding environmental conditions and lifestyle, Ocular Surface Disease Index, Dry Eye Questionnaire-5, non-Invasive (Oculus Keratograph 5 M) breakup time, tear film osmolarity and ocular surface staining parameters were assessed in a single clinical session to allow DED diagnosis based on the guidelines of the Tear Film and Ocular Surface Society Dry Eye Workshop II Diagnostic Methodology Report. A multivariate logistic regression model was constructed including those variables with a p-value less than 0.15 in the univariate analysis. Results: A prevalence of 57.7 % for DED was found. No age differences were found between those with and without DED (U = 1886.5, p = 0.243). Nevertheless, the DED group had more females (X2 = 7.033, p = 0.008). The univariate logistic regression identified as potential risk factors for DED the following: female sex, sleep hours per day, menopause, anxiety, systemic rheumatologic disease, use of anxiolytics, daily medication, ocular surgery, poor diet quality, more ultra-processed food in diet, not drinking caffeine and hours of exposure to air conditioning per day. Multivariate logistic regression revealed that hours of sleep per day, menopause and use of anxiolytics were independently associated with DED (p ≤ 0.026 for all). Conclusions: DED is associated with systemic, environmental and lifestyle risk factors. These findings are useful to identify potentially modifiable risk factors, in addition to conventional treatments for DED.

Original languageEnglish
Article number101539
JournalContact Lens and Anterior Eye
Early online date14 Nov 2021
Publication statusE-pub ahead of print - 14 Nov 2021

Bibliographical note

© 2021 The Author(s). Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY license

Funding Information:
This work was supported by the research and innovation programme under the Marie Sklodowska-Curie grant agreement [No. 642760 EDEN ITN-EJD Project Horizon 2020], an ?Atracci? de Talent? scholarship [UV-INV-PREDOC18F2-886420] awarded to Jose Vicente Garc?a-Marqu?s; and a ?Formaci?n de Profesorado Universitario? Scholarship [FPU17/03665, Ministerio de Educaci?n, Cultura y Deporte] awarded to Cristian Talens-Estarelles. The funding sources had no role in the preparation of the manuscript. The authors would like to thank Dr. Maria Vidal-Rohr for her contribution to the development of the study protocol.


  • Dry Eye Disease
  • Epidemiology
  • Ocular Surface
  • Risk factor
  • Tear Film


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