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
  • Maham 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

Dry eye is a complex syndrome defined by tear film instability that is influenced by a number of factors, including anxiety, sadness, and quality of disease. Objective: To determine the connections between anxieties, depression, dry eye and sleep quality. Methods: A cross-sectional study conducted at Madinah Teaching Hospital in Faisalabad using a non-probability sampling technique. Participants had to be between the ages of 20 and 35 and free of clinically serious eye abnormalities or known sleep problems in order to be included.  Those who were taking medication or had surgery within the last six months were not included.  Descriptive statistics, Pearson correlation, and multiple linear regression were used to analyze the results of the HADS, OSDI, and PSQI, which measure symptoms of anxiety and depression, dry eye, and sleep quality, respectively. Results: Descriptive statistics showed that the average age was 22.10 ± 1.94. Multiple linear regression was used to find a significant (p<0.001) association between the OSDI and PSQI subscales (sleep latency, sleep interruptions, and use of sleep aids).  Other factors that did not show statistically significant relationships with the regression model were subjective habitual sleep efficiency, sleep duration, sleep quality, and dysfunction throughout the day (p>0.001).  The assessment of multiple linear regression 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=0.001, and p<.001, respectively. Conclusions: Dry eye disease showed significant associations with depression and poor sleep quality but not with anxiety.

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

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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, M., & 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

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