Abstract:

Objective

To explore the correlation between dry eye symptoms，signs and anxiety and depression.

Methods

A total of 83 patients（166 eyes）in the Department of Ophthalmology of Peking University Third Hospital from June 2021 to December 2021 were collected.There were 9 males（18 eyes） and 42 females（84 eyes）with the average age of（51.0±16.1）years（ranged from 24 to 83 years）.According to the diagnostic criteria of dry eye，the patients were divided into dry eye group and control group.The dry eye symptoms of the subjects were evaluated by the ocular surface disease index questionnaire（OSDI）.The anxiety and depression scores of the patients were measured by the hospital anxiety and depression rating scale（HADS）.The infrared images of meibomian gland and corneal nerve images were collected by Oculus Keratograph 5M eye surface analyzer and corneal confocal laser scanning microscope，respectively.The meibomian gland area index and corneal nerve density were measured by ImageJ software.After examination，the OSDI score，HADS anxiety score，HADS depression score，meibomian gland index and corneal nerve density of the patients conformed to the normal distribution，and were expressed as.The difference of each index between the dry eye group and the control group was tested by independent sample t test.The correlation between the dry eye symptoms，signs and HADSscore in the dry eye group was analyzed by Pearson.The prediction model of dry eye symptoms and signs on hads score was analyzed by binary Logistics regression.

Results

The OSDI scores of patients in the dry eye group and the control group were（22.7±18.0）and（28.8±16.4）points，respectively，with a statistically significant difference（t=1.54，P＜0.05）.The meibomian gland index of patients in the dry eye group and the control group was（0.19±0.06）and（0.22±0.07），respectively，with a statistically significant difference（t=-2.20，P＜0.05）.The corneal nerve density of patients in the dry eye group and the control group was（2346.7±783.0）μm/mm² and（2419.8±386.5）μm/mm²，respectively，with a statistically significant difference（t=0.56，P＜0.05）.The HADSanxiety scores of patients in the dry eye group and the control group were（7.5±4.4）and（1.9±1.8）points，respectively，with a statistically significant difference（t=9.49，P＜0.05）.The HADSdepression scores of patients in the dry eye group and the control group were（7.5±3.1）and（3.5±2.6）points，respectively，with a statistically significant difference（t=6.08，P＜0.05）.The HADS anxiety score in patients with dry eye syndrome showed a weak positive correlation with OSDI score，a weak negative correlation with corneal nerve density，and a moderate negative correlation with meibomian gland index.All these correlations were statistically significant（r=0.37，-0.35，-0.43；P＜0.05）.The HADS depression score of patients in the dry eye group showed a moderate positive correlation with the OSDI score，and a moderate negative correlation with the meibomian gland index.The correlation was statistically significant（r=0.45，-0.52；P＜0.05）.Multivariate binary Logistics regression analysis revealed that the OSDI score，corneal nerve density，and meibomian gland index had statistically significant effects on the HADSanxiety score（OR=1.10，95%CI：1.04 to 1.16；P＜0.05），（OR=0.90，95%CI：0.81 to 0.98；P＜0.05），and（OR=0.87，95%CI：0.78 to0.95；P＜0.05）.Among them，the OSDI score was a risk factor for HADS anxiety score，while corneal nerve density and meibomian gland index were protective factors for HADS anxiety score.The impact of OSDI score and meibomian gland index on HADSdepression score was statistically significant（OR=1.07，95%CI：1.02 to 1.13；P＜0.05）and（OR=0.90，95%CI：0.82 to0.97；P＜0.05）.Specifically，OSDIscore was a risk factor for HADSanxiety score，while meibomian gland index was a protective factor for HADSanxiety score.

Conclusions

Dry eye patients are more likely to suffer from anxiety and depression than healthy individuals.OSDI score，corneal nerve density，and meibomian gland area index are significantly correlated with HADSscores.

Key words: Dry eye disease, Anxiety, Depression, Meibomian gland, Corneal nerve