title: Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters.
abstract: OBJECTIVE
  To evaluate the relationship between dry eye symptoms, non-ocular conditions and tear film parameters.
  
  
  METHODS
  
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The study population consisted of patients who were seen in the Miami Veterans Affairs eye clinic. Patients filled out standardised questionnaires assessing dry eye symptoms (dry eye questionnaire 5 (DEQ5) and ocular surface disease index (OSDI)), non-ocular pain, depression and post-traumatic stress disorder (PTSD), and also underwent measurement of tear film parameters.
  
  
  METHODS
  Correlations between dry eye symptoms and non-ocular conditions as compared with tear film parameters.
  
  
  RESULTS
  136 patients with a mean age of 65 (SD 11) years participated in the study. All correlations between the dry eye questionnaire scores (DEQ5 and OSDI) and (A) self-reported non-ocular pain measures (numerical rating scale and pain history), (B) depression and (C) PTSD were significant and moderate in strength (Pearson's coefficient 0.24 to 0.60, p<0.01 for all). All correlations between the dry eye questionnaires and tear film measures were weak (Pearson's coefficient -0.10 to 0.18) and most were not significant. Multivariable linear regression analyses revealed that PTSD and non-ocular pain more closely associated with dry eye symptoms than did tear film parameters. Specifically, non-ocular pain and PTSD accounted for approximately 36% of the variability in DEQ5 scores (R=0.60) and approximately 40% of variability in OSDI scores (R=0.64). Of note, none of the tear parameters remained significantly associated with dry eye symptoms in either model.
  
  
  CONCLUSIONS
  Dry eye symptoms more closely align to non-ocular pain, depression and PTSD than to tear film parameters.
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: Research service, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Felix
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
authors.forename: William
authors.identifier: http://orcid.org/0000-0002-9442-3076
authors.initials: W
authors.lastname: Feuer
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Shalabi
authors.affiliation: John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Eden R
authors.initials: ER
authors.lastname: Martin
authors.affiliation: Ophthalmology Department, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Margolis
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Constantine D
authors.initials: CD
authors.lastname: Sarantopoulos
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA Ophthalmology Department, Washington University School of Medicine, St. Louis, Missouri, USA Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Levitt
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry*
keywords: Ocular surface