The relationship between dry eye disease and anticholinergic burden

Anticholinergic drugs are widely prescribed for many medical conditions. However, data on the association of anticholinergic burden with dry eye disease (DED) are limited. In this study, we aimed to examine the relationship between anticholinergic burden and DED.

In this retrospective cohort study, we evaluated a total of 120 participants who underwent ophthalmological examination between February 2021 and February 2022. The drugs used by the patients in the last 2 months were recorded from the institute's electronic data system. Anticholinergic burden was assessed using the Anticholinergic Cognitive Burden (ACB) scale.

The mean age of those patients was 59.0 ± 11.6 years and more than half (n = 33, 64.7%) were women. Patients with DED had significantly higher Charlson comorbidity index scores (p = 0.01), lower Schirmer test values (p = 0.01), higher Ocular Surface Disease Index (OSDI) scores (p = 0.01), and higher anticholinergic burden (p = 0.01). There was a statistically significant positive correlation between ACB and OSDI scores (r = 0.22, p = 0.02) and a negative correlation between ACB scores and Schirmer test values (r = -0.46, p = 0.01). After adjusting for potential confounding factors (age, gender, and comorbidities), each 1-point increase in anticholinergic burden was found to result in a 2.97-fold increase in the risk of DED (OR: 2.97, 95% confidence interval: 1.22-7.24, p = 0.02).

Anticholinergic burden appears to be associated with DED. Therefore, greater caution in prescribing anticholinergic drugs for adult patients may be important in reducing the rates of many adverse outcomes.