Prevalence of Dry Eye Disease among Patients Attending an Ophthalmology Outpatient Department

Nadeem Ahmad; Rao Muhammad Tariq Aslam; Asma Mushtaq; Muhammad Ajmal Chaudhary; Muhammad Salman Nadeem

doi:10.54112/bcsrj.v7i3.2389

Authors

Nadeem Ahmad Institute of Ophthalmology and Allied Vision Sciences, Nishtar Medical University, Multan, Pakistan
Rao Muhammad Tariq Aslam Institute of Ophthalmology and Allied Vision Sciences, Nishtar Medical University, Multan, Pakistan
Asma Mushtaq Department of Paediatric Ophthalmology, The Children’s Hospital and Institute of Child Health, Faisalabad, Pakistan
Muhammad Ajmal Chaudhary Department of Paediatric Ophthalmology, The Children’s Hospital and Institute of Child Health, Faisalabad, Pakistan
Muhammad Salman Nadeem Final-Year MBBS Student, Nishtar Medical University, Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i3.2389

Keywords:

Dry Eye Disease; Ocular Surface Disease Index; Tear-Film Breakup Time; Digital-Screen Exposure; Diabetes Mellitus

Abstract

Dry eye disease is a common multifactorial ocular-surface disorder that may cause discomfort, visual disturbance and reduced quality of life. Local evidence regarding its prevalence and associated factors among ophthalmology outpatients in Pakistan remains limited. Objective: To determine the prevalence, severity and clinical phenotypes of dry eye disease and identify factors independently associated with the condition among patients attending an ophthalmology outpatient department. Methods: This analytical cross-sectional study was conducted at the ophthalmology outpatient department of a tertiary-care hospital from July to December 2025. A total of 80 adults were enrolled through consecutive non-probability sampling. Symptoms were assessed using the Ocular Surface Disease Index, while tear-film breakup time, Schirmer I testing and ocular-surface staining were performed. Dry eye disease was defined as an OSDI score of ≥13 with at least one abnormal objective test. Binary logistic regression was used to identify independently associated factors. Results: Dry eye disease was diagnosed in 28 participants, giving a prevalence of 35.0% (95% CI: 25.5%–45.9%). Among affected participants, 35.7% had mild, 35.7% moderate and 28.6% severe disease. Participants with dry eye disease had significantly higher OSDI scores and lower tear-film breakup time and Schirmer I measurements than those without the disease (all p<0.001). Evaporative dry eye was the most frequent phenotype, accounting for 50.0% of cases, followed by mixed disease at 32.1% and aqueous-deficient disease at 17.9%. Age ≥50 years (AOR: 14.58; 95% CI: 3.54–60.08), digital-screen use exceeding four hours daily (AOR: 5.86; 95% CI: 1.39–24.62) and diabetes mellitus (AOR: 6.07; 95% CI: 1.31–28.02) were independently associated with dry eye disease. Conclusion: Dry eye disease affected more than one-third of ophthalmology outpatients, with evaporative disease being the predominant phenotype. Older age, prolonged digital-screen exposure and diabetes mellitus were significant independent associated factors. Routine symptom screening and objective ocular-surface assessment may support earlier diagnosis and management in high-risk patients.

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References

1. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-83.

2. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017;15(3):539-74.

3. Papas EB. The global prevalence of dry eye disease: a Bayesian view. Ophthalmic Physiol Opt. 2021;41(6):1254-66.

4. Cai Y, Wei J, Zhou J, Zou W. Prevalence and incidence of dry eye disease in Asia: a systematic review and meta-analysis. Ophthalmic Res. 2022;65(6):647-58.

5. Sivakumar GK, Patel J, Malvankar-Mehta MS, Mather R. Work productivity among Sjögren’s syndrome and non-Sjögren’s dry eye patients: a systematic review and meta-analysis. Eye (Lond). 2021;35(12):3243-57.

6. Bazeer S, Jansonius N, Snieder H, Hammond CJ, Vehof J. The relationship between occupation and dry eye. Ocul Surf. 2019;17(3):484-90.

7. Al-Marri K, Al-Qashoti M, Al-Zoqari H, Elshaikh U, Naqadan A, Saeed R, et al. The relationship between smartphone use and dry eye disease: a systematic review with a narrative synthesis. Medicine (Baltimore). 2021;100(38).

8. Bu Y, Shih KC, Tong L. The ocular surface and diabetes, the other 21st century epidemic. Exp Eye Res. 2022;220:109099.

9. Hassanzadeh S, Varmaghani M, Zarei-Ghanavati S, Heravian Shandiz J, Azimi Khorasani A. Global prevalence of meibomian gland dysfunction: a systematic review and meta-analysis. Ocul Immunol Inflamm. 2021;29(1):66-75.

10. Arif SA, Khan MI, Abid MS, Babar A, Arif MA, Jahanzaib HM, et al. Frequency and impact of individual symptoms on quality of life in dry eye disease in patients presenting to a tertiary care hospital. J Pak Med Assoc. 2021;71(4):1063-8.

11. Ayub A, Akhtar FM, Saleem N, Ali MH, Ayub MH, Butt NH. Frequency and risk factors of dry eye disease in Pakistani population: a hospital-based study. Pak J Ophthalmol. 2017;33(4):196-203.

12. Mamoon I, Ayub F, Sarwat S. Prevalence of dry eye disease among IT students in Pakistan. Int Ophthalmol. 2024;44:204.

13. Akhtar N, Kausar A, Azeem HF, Shah A, Inam R, Mehmood A. Dry eye disease among young Pakistanis: association with digital screen use. J Coll Physicians Surg Pak. 2026;36(7):893-7.

14. Aljarousha M, Badarudin NE, Che Azemin MZ, Aljeesh Y, Amer A, Abdul Rahim MAS. Prevalence and risk factors of dry eye disease in the south of Palestine. Malays J Med Sci. 2024;31(2):72-97.

15. Li X, Wang Z, Mu J, Puerkaiti H, Nulahou A, Zhang J, et al. Prevalence and associated risk factors of dry eye disease in Hotan, Xinjiang: a cross-sectional study. BMC Ophthalmol. 2023;23(1):214.

16. Betiku AO, Oduyoye OO, Jagun OO, Olajide OS, Adebusoye SO, Aham-Onyebuchi UO. Prevalence and risk factors associated with dry eye disease among adults in a population-based setting in South-West Nigeria. Niger J Clin Pract. 2022;25(3):354-60.

17. Chatterjee S, Agrawal D, Sanowar G, Kandoi R. Prevalence of symptoms of dry eye disease in an urban Indian population. Indian J Ophthalmol. 2021;69(5):1061-6.

18. Bhatt K, Singh S, Singh K, Kumar S, Dwivedi K. Prevalence of dry eye, its categorization (Dry Eye Workshop II), and pathological correlation: a tertiary care study. Indian J Ophthalmol. 2023;71(4):1454-8.

19. Zhao M, Yu Y, Roy NS, Ying GS, Asbell P, Bunya VY. Sex-related differences and hormonal effects in the Dry Eye Assessment and Management (DREAM) study. Br J Ophthalmol. 2024;108(1):23-9.

20. Mdlalose PP, Moodley VR. Dry eye: a hospital-based sociodemographic, risk and clinical classification profile. Health SA. 2025;30:2793.

21. Chen Z, Xiao Y, Qian Y, Lin Q, Xiang Z, Cui L, et al. Incidence and risk factors of dry eye in children and adolescents with diabetes mellitus: a 3-year follow-up study. Front Med (Lausanne). 2021;8:760006.

22. Badian RA, Utheim TP, Chen X, Utheim OA, Ræder S, Ystenæs AE, et al. Meibomian gland dysfunction is highly prevalent among first-time visitors at a Norwegian dry eye specialist clinic. Sci Rep. 2021;11(1):23412.

23. Vidal-Rohr M, Craig JP, Davies LN, Wolffsohn JS. Classification of dry eye disease subtypes. Cont Lens Anterior Eye. 2024;47(5):102257.

24. Asiedu K, Kyei S, Adanusa M, Ephraim RKD, Animful S, Ali-Baya SK, et al. Dry eye, its clinical subtypes and associated factors in healthy pregnancy: a cross-sectional study. PLoS One. 2021;16(10).