Ocular Surface Health in Connection with Anxiety and Depression: a Review

Psychosomatic ophthalmology emerged after World War II because patients attended clinics with symptoms that were not explained by physiological findings, subsequently it became clear that psychological distress could be associated with several ocular disorders, including dry eye syndrome. Dry eye disease is a common disorder with increasing prevalence due to environmental factors such as pollution, smoking, and sleep disorders. The burden of dry eye disease affects both patients and society, making it a very important target for investigation. Numerous studies showed that dry eye disease prevalence including the severity of the symptoms of dry eye is higher in patients suffering from depression and/or anxiety. Some studies suggest the implication of serotonin in tears being dysregulated by the disorders. The current review highlights the evidence of the association between anxiety, depression, and dry eye disease and summarizes the recent advances in research in this area, together with a brief explanation of the physiology of stress that could lead to psychological disorders.