Exploring the Association Between Lipid-Lowering Medications and Dry Eye Disease in COVID-19 Patients

To explore the associations between systemic lipid-lowering medications and dry eye disease (DED) in patients hospitalized for SARS-CoV-2.

This retrospective cohort study analyzed electronic medical records of SARS-CoV-2 patients hospitalized at Shaare Zedek Medical Center from April 1, 2020, to December 31, 2024. Adults without a previous DED diagnosis who had an ophthalmologic examination confirming no DED within the year preceding hospitalization were included. Exclusions included ICU admissions, specific systemic conditions, ocular surgeries, and systemic medications known to induce DED. Patients were categorized into those who developed DED within six months post-hospitalization and those who did not.

Among the 1,165 patients, 167 (14.3%) developed DED post-hospitalization. After adjusting for age, gender, and SARS-CoV-2 vaccination status, an inverse association between statins and dry eye disease was evident. Treatment with any statin was associated with reduced odds of developing dry eye disease (OR 0.289, p<0.001), particularly with atorvastatin (OR 0.374, p<0.001) and simvastatin (OR 0.297, p<0.001).

The inverse association observed in this study supports a potential protective effect of statins, consistent with their known anti-inflammatory properties and their ability to reduce cholesterol-driven Meibomian gland dysfunction.

Statin use is inversely associated with the development of DED in SARS-CoV-2 hospitalized patients. The anti-inflammatory and cholesterol-lowering effects of statins provide a robust framework for understanding the underlying pathophysiological mechanisms.