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Risk of Incident Dry Eye Disease Among Patients With Chronic Pain Conditions
Shannan Berzack1, Shon B Shmushkevich1, Charles Zhang2
1From the Herbert Wertheim College of Medicine (S.B., S.B.S.), Florida International University, Miami, Florida, USA; Bascom Palmer Eye Institute (S.B., S.B.S., C.Z., A.G.), University of Miami Miller School of Medicine, Miami, Florida, USA.
American Journal of Ophthalmology
|July 17, 2026
Summary
Chronic pain conditions (CPCs) significantly increase the risk of developing dry eye disease (DED). Patients with CPCs were over 4 times more likely to develop incident DED and over 2 times more likely to require prescription treatment.
Area of Science:
- Ophthalmology
- Pain Medicine
- Epidemiology
Background:
- Chronic pain conditions (CPCs) affect a significant portion of the population.
- Dry eye disease (DED) is a prevalent ocular condition with various risk factors.
- The potential link between CPCs and DED has not been extensively studied.
Purpose of the Study:
- To investigate the association between CPCs and the incidence of DED.
- To determine if CPCs increase the risk of developing prescription-requiring DED.
- To evaluate this association in a large-scale electronic health record network.
Main Methods:
- Retrospective cohort study utilizing the TriNetX Analytics Network (2005-2025).
- Propensity score matching was used to compare patients with and without CPCs.
- Incident DED and prescription-requiring DED were assessed at 1, 2, and 3 years post-index visit.
Main Results:
- Patients with CPCs demonstrated a significantly higher risk of incident DED at all follow-up intervals (e.g., RR 4.78 at 3 years).
- The incidence of prescription-requiring DED was also elevated in the CPC cohort (RR 2.60 at 3 years).
- Findings were consistent across primary and validation cohorts, confirming the robustness of the association.
Conclusions:
- Chronic pain conditions are strongly associated with an increased risk of both incident and prescription-requiring DED.
- CPCs should be considered significant risk factors in the clinical evaluation and management of DED.
- A portion of DED cases may be linked to underlying systemic pain-processing abnormalities.
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