• Anat Galor, Elizabeth R Felix, William Feuer, Nabeel Shalabi, Eden R Martin, Todd P Margolis, Constantine D Sarantopoulos, and Roy C Levitt.
• Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
• Br J Ophthalmol. 2015 Aug 1; 99 (8): 1126-9.

ObjectiveTo evaluate the relationship between dry eye symptoms, non-ocular conditions and tear film parameters.MethodsDesignCross-sectional study.Participants/SettingThe 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.Main Outcome MeasuresCorrelations between dry eye symptoms and non-ocular conditions as compared with tear film parameters.Results136 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.ConclusionsDry eye symptoms more closely align to non-ocular pain, depression and PTSD than to tear film parameters.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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