Is myopia a risk factor for dry eye disease?

Paper title: Relationship between myopia and diagnosis rates of dry eye disease and related indicators: a systematic review and meta-analysis

Authors: Wu K (1,2), Yu Y (2), Shi J (3), Chen H (1,2), Xie C (1,2), Tang Y (1,2), Yao X (1,2)

1. Department of Ophthalmology, The First Hospital of Hunan University of Chinese Medicine, Changsha, China
2. First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
3. College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, China

Date: Published online March 27, 2025

Reference: Wu K, Yu Y, Shi J, Chen H, Xie C, Tang Y, Yao X. Relationship between myopia and diagnosis rates of dry eye disease and related indicators: a systematic review and meta-analysis. Front Med (Lausanne). 2025 Mar 27; 12:1541304.

[Link to open access paper]

Dry eye disease (DED) is a common ocular surface disorder with complex, multifactorial causes. Although myopia and dry eye disease (DED) appear unrelated, some researchers have proposed that behavioural factors common in myopic individuals, such as prolonged screen use and reduced blink rate, may contribute to tear film instability and increase dry eye risk. Previous studies have explored this association, but the overall quality of evidence has been low.

This systematic review and meta-analysis aimed to compare the diagnosis rates of DED between myopic and emmetropic individuals, to determine whether myopia is a risk factor for dry eye.

 Eight retrospective cross-sectional studies, published between 2012 and 2024, were included. They comprised 14,232 eyes (11,619 myopic and 2,613 emmetropic). Participants were primarily students with a mean age of 17.5 years, and studies were conducted across China, Japan, and Turkey. Diagnostic methods for DED varied across studies. Key outcome measures included DED diagnosis rate, tear break-up time (BUT), and corneal staining.

Key findings were as follows.

• Myopic eyes showed a 104% higher DED diagnosis rate compared to emmetropic eyes.
• Tear break-up time was shorter in the myopic group by 6.31 seconds, compared with the emmetropic group.
• There was no difference in the rate of positive corneal staining.
• Evidence quality for all outcomes was rated as extremely low.

As it was found that myopic patients had a higher rate of diagnosis for DED and reduced tear break-up time compared to emmetropes, myopia may be a potential risk factor for DED. 

The authors propose that reduced blink frequency and prolonged screen use in myopic individuals may contribute to evaporative dry eye. While no difference was found in corneal staining, the reduced tear break-up time may reflect tear film instability in the absence of overt surface damage.

Although the quality of evidence was low, the findings suggest that young myopic individuals could benefit from a dry eye assessment. The authors recommend those with mild myopia undergo “a tear secretion test, BUT and corneal fluorescent staining every two years,” and those with high myopia to perform these tests annually. 

Given the study population was primarily composed of students, the recommendations may be most applicable to young adults.

This study had several limitations that affect how confidently the results can be interpreted and applied. 

As the meta-analysis only included cross-sectional studies, a causative relationship could not be drawn between myopia and DED. Most studies were conducted in Southeast Asia and involved student populations, so the findings may not reflect older adults or people in other regions. 

Only two studies reported tear break-up time (BUT) and positive corneal staining, which limited further analysis of these outcomes. The severity of myopia was also not consistently reported, making it unclear whether the risk of DED increases with myopia or vice-versa.

There was also considerable variation in how DED was diagnosed across studies. Some studies used symptom-based questionnaires such as the OSDI and McMonnies scales, while others applied clinical criteria including the 2013 Chinese Expert Consensus and the 2017 Asia Dry Eye Society guidelines – both of which differ from TFOS DEWS II, which recommends assessing both symptoms and clinical signs. 

Future studies should use standardised DED diagnostic criteria and include a broader range of age groups, regions, and degrees of myopia to better understand the nature and strength of this relationship.

Background: The association between myopia and dry eye disease (DED) has recently garnered considerable attention. This study aimed to compare the diagnosis rates of DED and its indicators between myopic and emmetropic patients to elucidate the association between myopia and DED.

Methods: We retrieved relevant literature published through November 2024 from English databases, such as PubMed, Embase, the Cochrane Library, and Web of Science, as well as Chinese databases, such as the China National Knowledge Infrastructure, WanFang, VIP, and SinoMed. The studies were then screened for inclusion and exclusion criteria, and the basic information and outcome data of the included studies were recorded. The methodological quality of the included studies was assessed by the Joanna Briggs Institute. Finally, RevMan 5.3 was used to perform meta-, subgroup, and sensitivity analyses, as well as a publication bias assessment of the outcome data.

Results: This study included 8 studies with a sample size of 14,232 patients. The meta-analysis showed that compared with emmetropic eyes, the diagnostic rate of DED in myopic eyes increased significantly, by 104% [odds ratio (OR) = 2.04, 95% confidence interval (CI) = 1.39–2.99, P = 0.0002, I² = 91%], while the tear break-up time (BUT) was reduced significantly, by 6.31 s [weighted mean difference (WMD) = –6.31, 95% CI = –7.32 to –5.29, P < 0.00001, I² = 0%]. However, there was no significant difference in the rate of positive corneal staining (OR = 2.53, 95% CI = 0.22–29.07, P = 0.46, I² = 68%). Funnel plots showed a potential publication bias in DED diagnosis rate, rate of positive corneal staining, and BUT. An evaluation showed that the evidence quality of DED diagnosis rate, BUT and rate of positive corneal staining were extremely low.

Conclusion: There were significant differences in the DED diagnosis rate and BUT between myopic and emmetropic patients, suggesting that myopia may be a potential risk factor for DED. The regular screening for DED should be a focus in myopic populations to improve detection and diagnosis rates.

[Link to open access paper]