Christopher J. Rapuano, MD

Disclosures

January 19, 2016

Viewpoint

Eye care professionals who have treated a large number of patients with dry eye disease have most likely noted that many more of these patients seem depressed, have active depression, or have a history of depression than most of their other patients. I know that my partners and I have certainly noticed it. We do not know for sure why that is the case. We have discussed many theories: The chronic painful symptoms of dry eye disease can cause depression, the medications used to treat depression can cause or exacerbate dry eye disease, or the same underlying mechanism (eg, hormonal or metabolic imbalance) that causes depression can also cause dry eye disease.

This study confirmed that the correlation between dry eye symptoms and depressive symptoms is fairly strong. An odds ratio of 2.79 means that dry eye patients are 2.79 times more likely to report a certain level of depressive symptoms than controls after adjusting for variables such as psychiatric medications. We know that many medications for depression and anxiety can induce or aggravate dry eye symptoms. As clinicians, we were never sure about which came first, dry eye or depression, which required medication therapy that worsened dry eye symptoms. Although we still don't know the answer to that question, this small study supports taking the effect of the psychiatric medications out of the equation.

How can we use this information? I hope that it will lead to better studies investigating the relationship between dry eyes and depression. Is there a single underlying systemic abnormality that is causing both of these conditions? What effect does treating depression have on dry eye symptoms? The Symptom Burden Tool has been used for chronic conditions with pain. Is there a relationship between chronic pain, depression, and dry eyes? Does treating chronic pain help depression or dry eyes?

Another way to use this information is to consider asking patients with dry eyes about symptoms of depression. In this study, 21% of patients with significant depressive symptoms had no history of prior antidepressant or antianxiety medication use and did not appear to have been previously diagnosed with depression. It might be helpful to explain to patients that their dry eye symptoms may be related to their depressive symptoms and that they should consider an evaluation for depression if significant symptoms are present.

The fact that many of our dry eye patients may have undiagnosed or untreated depressive symptoms should remind us to be especially compassionate when treating them. Although we should be compassionate with all of our patients, it is often more difficult with some of our dry eye patients due to its chronic nature and our often less-than-effective treatment options.

Abstract

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