title: Depression, post-traumatic stress disorder, and dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative database.
abstract: OBJECTIVE
  To study the scope of dry eye syndrome (DES) in veterans on a national level and to evaluate the relationship between psychiatric diagnoses and DES.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  
  
  
  METHODS
  Patients were seen in a Veterans Affairs (VA) eye clinic between 2006 and 2011.
  
  
  METHODS
  Patients were divided into cases and controls with regard to their dry eye status (cases = ICD-9 code for DES plus dry eye therapy; controls = patients without ICD-9 code plus no therapy).
  
  
  METHODS
  The prevalence of DES and the influence of psychiatric diagnoses on the risk of DES.
  
  
  RESULTS
  A total of 2 454 458 patients were identified as either a dry eye case (n = 462 641) or control (n = 1 991 817). Overall, 19% of male patients and 22% of female patients had a diagnosis of DES, with female sex imparting an increased risk of DES at each decade compared to male sex (odds ratio [OR] 1.22-2.09). Several conditions were found to increase DES risk, including post-traumatic stress disorder (OR 1.92, 95% CI 1.91-1.94) and depression (OR 1.92, 95% CI 1.91-1.94) (analyses adjusted for sex and age). The use of several systemic medications was likewise associated with an increased risk of DES, including antidepressant medications (OR 1.97, 95% CI 1.79-2.17) and antianxiety medication (OR 1.74, 95% CI 1.58-1.91). Multivariate analysis (adjusted for age and sex) revealed that for psychiatric diagnoses, both the use of medication and the diagnosis remained significant risk factors when considered concomitantly, although the magnitude of each association decreased.
  
  
  CONCLUSIONS
  DES is a disease associated with depression and post-traumatic stress disorder, and is prevalent among male and female veterans receiving eye care services. The association could be driven by underlying disease physiology or medications used to treat psychiatric conditions. Regardless of the causal link, this suggests that individuals with a known psychiatric diagnosis should be questioned about dry eye symptoms and, if applicable, referred to an eye care physician.
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA. agalor@med.miami.edu
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.forename: William
authors.initials: W
authors.lastname: Feuer
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
authors.forename: Hermes
authors.initials: H
authors.lastname: Florez
authors.forename: Allen L
authors.initials: AL
authors.lastname: Faler
authors.forename: Kasey L
authors.initials: KL
authors.lastname: Zann
authors.forename: Victor L
authors.initials: VL
authors.lastname: Perez
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents