title: Dry eye syndrome, posttraumatic stress disorder, and depression in an older male veteran population.
abstract: OBJECTIVE
  To evaluate whether veterans with posttraumatic stress disorder (PTSD) or depression have differences in dry eye symptoms and signs compared to a population without these conditions.
  
  
  METHODS
  Male patients aged ≥50 years with normal eyelid, conjunctival, and corneal anatomy were recruited from the Miami Veterans Affairs Eye Clinic (N = 248). We compared dry eye symptoms (determined by the Dry Eye Questionnaire 5 [DEQ5] score) to tear film indicators obtained by clinical examination (i.e., tear osmolarity, corneal staining, tear breakup time, Schirmer's, meibomian gland quality, orifice plugging, lid vascularity) between patients with PTSD or depression and those without these conditions. Student's t-tests, χ(2) analyses, and linear and logistic regressions were used to assess differences between the groups.
  
  
  RESULTS
  DEQ5 scores were higher in the PTSD (mean = 13.4; standard error [SE] = 1.1; n = 22) and depression (mean = 12.0; SE = 0.8; n = 40) groups compared to the group without these conditions (mean = 9.8; SE = 0.4; n = 186; P < 0.01 and P = 0.02, respectively). More patients in the PTSD and depression groups had severe dry eye symptoms, defined as a DEQ5 score ≥ 12 (77% and 63% vs. 41%; P < 0.01 and P = 0.02, respectively). No significant differences in tear film indicators were found among the three groups. Multivariable logistic regression indicated that a PTSD diagnosis (odds ratio [OR] = 4.08; 95% confidence interval [CI] = 1.10-15.14) and use of selective serotonin reuptake inhibitors (OR = 2.66; 95% CI = 1.01-7.00) were significantly associated with severe symptoms.
  
  
  CONCLUSIONS
  Patients with PTSD have ocular surface symptoms that are not solely explained by tear indicators. Identifying underlying conditions associated with ocular discomfort is essential to better understand the mechanisms behind ocular pain in dry eye syndrome.
authors: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33125, USA.
authors: Cristina A
authors: CA
authors: Fernandez
authors: Anat
authors: A
authors: Galor
authors: Kristopher L
authors: KL
authors: Arheart
authors: Dominique L
authors: DL
authors: Musselman
authors: Vincent D
authors: VD
authors: Venincasa
authors: Hermes J
authors: HJ
authors: Florez
authors: David J
authors: DJ
authors: Lee
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D015352:Dry Eye Syndromes / Q000453:epidemiology*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D002097:C-Reactive Protein
keywords: depression; dry eye syndrome; posttraumatic stress disorder; veterans