Correlation of ocular surface function with sleep quality, anxiety, and depression in patients with dry eye disease

Dry eye disease (DED) is a multifactorial ocular surface disorder with rising prevalence. It is closely related to systemic health and psychological factors, such as sleep and mood disorders, which significantly impact the quality of life of patients.

To explore the correlations between ocular surface function, sleep quality, and anxiety/depression in patients with DED.

This was a cross-sectional investigative study that included 358 patients with DED between January 2022 and January 2025. Ocular surface was assessed using the ocular surface disease index (OSDI), tear film break-up time, fluorescein staining score, and Schirmer I test. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to evaluate sleep quality and anxiety/depression levels. Correlation and linear regression analyses were used to explore the relationships.

The mean PSQI score of the patients was 9.94 ± 2.18; the mean SAS score was 47.30 ± 4.90, and the mean SDS score was 50.08 ± 5.52. These suggested a prevalence of sleep and psychological abnormalities. There was a significant correlation between the indicators of ocular surface function (OSDI, tear film break-up time, fluorescein staining, and Schirmer I test) and PSQI, SAS, and SDS scores (P < 0.05). Moreover, multiple regression revealed that age ≥ 50 years (β = 1.55, P = 0.029), PSQI scores (β = 0.58, P < 0.001), SAS scores (β = 0.17, P = 0.017), and SDS scores (β = 0.15, P = 0.019) were independent predictors of the OSDI scores.

Ocular surface function in patients with DED is closely related to sleep quality and anxiety/depression, emphasizing the need for holistic clinical management.