Association of Dry Eye, Sleep Quality, Anxiety and Depression among Young Pakistani Adults: A Cross- Sectional Study

Dry Eye, Sleep, Anxiety, and Depression in Young Adults

Authors

  • Maryam Jabbar Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan
  • Ayesha Asim Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan
  • Syeda Rakia Bukhari Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan
  • Sonia Basri Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan
  • Alishba Hayat Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan
  • Haram Waqas Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan
  • Misbah Safdar Department of Optometry, The University of Faisalabad, Faisalabad, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v8i7.1267

Keywords:

Dry Eye Disease, Depression, Sleep Quality, Hospital Anxiety And Depression Scale, Pittsburgh Sleep Quality Index

Abstract

Tear film instability is a hallmark of dry eye disease, a multifactorial disorder which is affected by several variables such as sleep quality, depression and anxiety. Objectives: To examine the connections between anxiety, depression, dry eye and sleep quality. Methods: A cross-sectional study was carried out at Madinah Teaching Hospital, Faisalabad. Prerequisites for inclusion were being between the ages of 20-35 years and not having any clinically significant eye disorders or reported sleep disorders. Patients who were taking medication or who had undergone surgery in the six months prior were not included. Descriptive statistics, Pearson correlation and multiple linear regression were used to assess the results of the HADS, OSDI and PSQI, which were used to measure symptoms of anxiety and depression, dry eye and sleep quality, respectively. Results: Multiple linear regression revealed a significant (p<0.001) relationship between the OSDI and PSQI subscales (sleep latency, sleep disturbances and use of sleep medications). Other indicators that did not show statistically significant relationships with the regression model included subjective sleep quality, sleep duration, habitual sleep efficiency, and dysfunction during the day (p>0.001). Multiple linear regression analysis revealed that the OSDI and the other variables HADS-A, HADS-D and PSQI total score were related to the following values: p=0.29, p=0.001and p<0.001, respectively. Conclusions: Dry eye was closely associated with depression and disturbed sleep, although it did not significantly correlate with anxiety. The OSDI scores and the PSQI subscale showed significant associations, suggesting a link between dry eye and sleep quality.   

References

Hakim FE and Farooq AV. Dry eye disease: an update in 2022. Journal of the American Medical Association. 2022 Feb; 327(5): 478-9. doi: 10.1001/jama.2021.19963. DOI: https://doi.org/10.1001/jama.2021.19963

Papas EB. The global prevalence of dry eye disease: A Bayesian view. Ophthalmic and Physiological Optics. 2021 Nov; 41(6): 1254-66. doi: 10.1111/opo.12888. DOI: https://doi.org/10.1111/opo.12888

Chan C, Ziai S, Myageri V, Burns JG, Prokopich CL. Economic burden and loss of quality of life from dry eye disease in Canada. British Medical Journal Open Ophthalmology. 2021 Sep; 6(1). doi: 10.1136/bmjophth-2021-000709. DOI: https://doi.org/10.1136/bmjophth-2021-000709

Tsubota K, Pflugfelder SC, Liu Z, Baudouin C, Kim HM, Messmer EM et al. Defining dry eye from a clinical perspective. International Journal of Molecular Sciences. 2020 Dec; 21(23): 9271. doi: 10.3390/ijms21239271. DOI: https://doi.org/10.3390/ijms21239271

Pan H, Pan X, Gu D, Wang X. Effects of social support on vision-related quality of life in older adults with dry eye disease: the chain mediating role of illness perception and coping style. Frontiers in Psychology. 2024 Jul; 15:1411661. doi: 10.3389/fpsyg.2024.1411661. DOI: https://doi.org/10.3389/fpsyg.2024.1411661

Cutrupi F, De Luca A, Di Zazzo A, Micera A, Coassin M, Bonini S. Real life impact of dry eye disease. InSeminars in Ophthalmology. 2023 Nov; 38(8): 690-702. doi: 10.1080/08820538.2023.2204931. DOI: https://doi.org/10.1080/08820538.2023.2204931

Liu M, Kumar A, Bukkapatnam S, Kuttolamadom M. A review of the anomalies in directed energy deposition (DED) processes & potential solutions-part quality & defects. Procedia Manufacturing. 2021 Jan; 53: 507-18. doi: 10.1016/j.promfg.2021.06.093. DOI: https://doi.org/10.1016/j.promfg.2021.06.093

Oganov A, Yazdanpanah G, Jabbehdari S, Belamkar A, Pflugfelder S. Dry eye disease and blinking behaviors: A narrative review of methodologies for measuring blink dynamics and inducing blink response. The Ocular Surface. 2023 Jul; 29: 166-74. doi: 10.1016/j.jtos.2023.05.011. DOI: https://doi.org/10.1016/j.jtos.2023.05.011

Sabucedo-Villamarin B, Garcia-Queiruga J, Cacabelos-Torres L, Giraldez MJ, Yebra-Pimentel E, Pena-Verdeal H. Short-Term Changes in Tear Film Stability and Tear Volume Following the Application of Various DED Management Options in a Healthy Young Population. Journal of Personalized Medicine. 2025 Apr; 15(5): 173. doi: 10.3390/jpm15050173. DOI: https://doi.org/10.3390/jpm15050173

Morthen MK, Magno MS, Utheim TP, Snieder H, Hammond CJ, Vehof J. The physical and mental burden of dry eye disease: a large population-based study investigating the relationship with health-related quality of life and its determinants. The Ocular Surface. 2021 Jul; 21: 107-17. doi: 10.1016/j.jtos.2021.05.006. DOI: https://doi.org/10.1016/j.jtos.2021.05.006

Bijwadia J. Current Classification of Sleep Disorders. InDental Sleep Medicine: A Clinical Guide. 2022 Sep: 71-101. doi: 10.1007/978-3-031-10646-0_3. DOI: https://doi.org/10.1007/978-3-031-10646-0_3

Anghel L, Ciubară A, Nechita A, Nechita L, Manole C, Baroiu L et al. Sleep disorders associated with neurodegenerative diseases. Diagnostics. 2023 Sep; 13(18): 2898. doi: 10.3390/diagnostics13182898. DOI: https://doi.org/10.3390/diagnostics13182898

Li A, Zhang X, Guo Y, Wang J, Hao Y, Gu Y et al. The association between dry eye and sleep disorders: the evidence and possible mechanisms. Nature and Science of Sleep. 2022 Dec: 2203-12. doi: 10.2147/NSS.S378751. DOI: https://doi.org/10.2147/NSS.S378751

Sariyeva İsmayılov A and Aydin Guclu O. The effect of OSAS risk, excessive daytime sleepiness, insomnia severity and sleep quality on dry eye syndrome. Sleep and Biological Rhythms. 2020 Jul; 18(3): 259-65. doi: 10.1007/s41105-020-00267-9. DOI: https://doi.org/10.1007/s41105-020-00267-9

An Y and Kim H. Sleep disorders, mental health, and dry eye disease in South Korea. Scientific Reports. 2022 Jun; 12(1): 11046. doi: 10.1038/s41598-022-14167-0. DOI: https://doi.org/10.1038/s41598-022-14167-0

Citradewi AA, Widiana IG, Susila NK, Djelantik AA. Correlation of depression, anxiety and stress level on dry eye disease severity. International Journal of Health Sciences. 2022 Sep; 6(S9): 1733-44. doi: 10.53730/ijhs.v6nS9.12747. DOI: https://doi.org/10.53730/ijhs.v6nS9.12747

McCann P, Abraham AG, Mukhopadhyay A, Panagiotopoulou K, Chen H, Rittiphairoj T et al. Prevalence and incidence of dry eye and meibomian gland dysfunction in the United States: a systematic review and meta-analysis. Journal of the American Medical Association Ophthalmology. 2022 Dec; 140(12): 1181-92. doi: 10.1001/jamaophthalmol.2022.4394. DOI: https://doi.org/10.1001/jamaophthalmol.2022.4394

Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Archives of Ophthalmology. 2000 May; 118(5): 615-21. doi: 10.1001/archopht.118.5.615. DOI: https://doi.org/10.1001/archopht.118.5.615

Zarrabi H, Novin MH, Soleimani R, Shirkhan Maleki B, Speily SK. The Psychometric Properties of the Persian Version of the Smoking Urge Questionnaire in the General Population. Caspian Journal of Neurological Sciences. 2024 Jul; 10(3): 218-24. doi: 10.32598/CJNS.10.38.488.1. DOI: https://doi.org/10.32598/CJNS.10.38.488.1

Snaith RP and Zigmond AS. The hospital anxiety and depression scale. British Medical Journal (Clinical research ed.). 1986 Feb; 292(6516): 344. doi: 10.1136/bmj.292.6516.344. DOI: https://doi.org/10.1136/bmj.292.6516.344

Wu M, Liu X, Han J, Shao T, Wang Y. Association between sleep quality, mood status, and ocular surface characteristics in patients with dry eye disease. Cornea. 2019 Mar; 38(3): 311-7. doi: 10.1097/ICO.0000000000001854. DOI: https://doi.org/10.1097/ICO.0000000000001854

Toth M and Jokić-Begić N. Psychological contribution to understanding the nature of dry eye disease: a cross-sectional study of anxiety sensitivity and dry eyes. Health Psychology and Behavioral Medicine. 2020 Jan; 8(1): 202-19. doi: 10.1080/21642850.2020.1770093. DOI: https://doi.org/10.1080/21642850.2020.1770093

Zhou Y, Murrough J, Yu Y, Roy N, Sayegh R, Asbell P et al. Association between depression and severity of dry eye symptoms, signs, and inflammatory markers in the DREAM study. Journal of the American Medical Association Ophthalmology. 2022 Apr; 140(4): 392-9. doi: 10.1001/jamaophthalmol.2022.0140. DOI: https://doi.org/10.1001/jamaophthalmol.2022.0140

Nuzzi R and Caselgrandi P. Sex hormones and their effects on ocular disorders and pathophysiology: current aspects and our experience. International Journal of Molecular Sciences. 2022 Mar; 23(6): 3269. doi: 10.3390/ijms23063269. DOI: https://doi.org/10.3390/ijms23063269

Basilious A, Xu CY, Malvankar-Mehta MS. Dry eye disease and psychiatric disorders: a systematic review and meta-analysis. European Journal of Ophthalmology. 2022 Jul; 32(4): 1872-89. doi: 10.1177/11206721211060963. DOI: https://doi.org/10.1177/11206721211060963

He Q, Chen Z, Xie C, Liu L, Wei R. The association between dry eye disease with depression, anxiety and sleep disturbance during COVID-19. Frontiers in Psychiatry. 2022 Jan; 12: 802302. doi: 10.3389/fpsyt.2021.802302. DOI: https://doi.org/10.3389/fpsyt.2021.802302

Magno MS, Utheim TP, Snieder H, Hammond CJ, Vehof J. The relationship between dry eye and sleep quality. The Ocular Surface. 2021 Apr; 20: 13-9. doi: 10.1016/j.jtos.2020.12.009. DOI: https://doi.org/10.1016/j.jtos.2020.12.009

Ayaki M, Toda I, Tachi N, Negishi K, Tsubota K. Preliminary report of improved sleep quality in patients with dry eye disease after initiation of topical therapy. Neuropsychiatric Disease and Treatment. 2016 Feb: 329-37. doi: 10.2147/NDT.S94648. DOI: https://doi.org/10.2147/NDT.S94648

Downloads

Published

2025-07-31
CITATION
DOI: 10.54393/pbmj.v8i7.1267
Published: 2025-07-31

How to Cite

Jabbar, M., Asim, A., Bukhari, S. R., Basri, S., Hayat, A., Waqas, H., & Safdar, M. (2025). Association of Dry Eye, Sleep Quality, Anxiety and Depression among Young Pakistani Adults: A Cross- Sectional Study : Dry Eye, Sleep, Anxiety, and Depression in Young Adults. Pakistan BioMedical Journal, 8(7), 20–25. https://doi.org/10.54393/pbmj.v8i7.1267

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)