Dry Eye-Related Visual Blurring and Irritative Symptoms and Their Association with Depression and Anxiety in Eye Clinic Patients.
Dry eye is a common condition known to have many systemic co-morbidities. We aim to report the frequency of depression and anxiety suspects in eye clinic patients and explore the association between dry eye signs and symptoms with depression and anxiety.



Adult outpatients were recruited from dry a public tertiary ophthalmology specialist center. Participants underwent socio-demographic and dry eye symptoms questionnaires, fluorescein dye tear break-up time (TBUT), fluorescein dye corneal staining and Schirmer's test. Rasch analysis was used to internally validate the Hospital Anxiety and Depression Scale (HADS) and the Center for Epidemiologic Studies Depression Scale (CES-D) and determine its psychometric properties.



A total of 96 participants (mean age 54.5 ± 10.8; 64.1% women) were recruited. The mean score for the CES-D was 12.1 ± 9.8 with 28 participants (31.5%) having a score of above 16 (published threshold). The mean score for depression-associated questions in the HADS was 3.6 ± 3.6 with 13 participants (14.1%) having a score ≥8. The mean score for the anxiety-associated questions in the HADS was 5.3 ± 3.6 with 24 participants (26.1%) having score ≥8. There was a weak inverse correlation between Schirmer's test and CES-D scores. Elevated depression scores from the CES-D were significantly associated with visual blurring but not irritation, in dry eye patients with low TBUT.



In conclusion, specific types of dry eye symptoms, particularly those with increased frequency of visual blurring were associated with symptoms of depression. The optical aberrations induced by dry eye, associated with tear instability, may predispose to depressive tendency.
a Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore .
Hong
H
Liyue
b Singapore Eye Research Institute , Singapore , Singapore .|c Duke-NUS Graduate Medical School , Singapore , Singapore .|d University of Melbourne , Parkville , Australia .
Peggy Pei-Chia
PP
Chiang
c Duke-NUS Graduate Medical School , Singapore , Singapore .|e Institute of Mental Health , Singapore , Singapore and.
Sharon C
SC
Sung
a Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore .|b Singapore Eye Research Institute , Singapore , Singapore .|c Duke-NUS Graduate Medical School , Singapore , Singapore .|f Singapore National Eye Center , Singapore , Singapore.
Louis
L
Tong
D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D015352:Dry Eye Syndromes / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity
Anxiety; clinical study; depression; dry eye; symptoms