Chronic Pain Linked to Higher Risk of Dry Eye Disease, finds study
Researchers have found in a new study that patients with chronic pain conditions are at a significantly higher risk of developing dry eye disease and are more likely to require prescription topical eye treatments compared with individuals without chronic pain, highlighting the need for regular ocular evaluation in this population. The study was published in the American Journal of Ophthalmology by Shannan B. and colleagues.
In order to investigate the effect of pre-existing pain syndromes on the incidence of dry eye syndrome, researchers reviewed data from the TriNetX analytics network, including the health records of adults aged 18 years or older who had a baseline ophthalmologic assessment but did not have any previous history of DED. The exposure group consisted of individuals who were already diagnosed with at least one chronic pain condition (CPC) before the index visit while the control group consisted of individuals without any history of CPC either before or after the index date.
By using ICD-10-CM, SNOMED, and CPT diagnostic codes, investigators used 1:1 propensity score matching to carefully match demographic and other medical factors to create matched groups of 538,364 subjects. In order to verify results from potential surveillance bias, investigators used a secondary validation cohort which was limited to those subjects being evaluated for age-related cataracts and included 506,763 matched patients per group. The primary outcome measures included new DED and medication-requiring DED (cyclosporine or lifitegrast therapy).
Key findings:
- Patients who had at least one diagnosis of a chronic pain condition had a significantly higher incidence of dry eye disease compared to the control group (CPCs) at all follow-up periods.
- In the first year, 3.34% of patients who had CPCs developed dry eye disease versus 0.72% in the control group (relative risk = 4.64; 95% confidence interval, 4.49-4.81; P < 0.0001).
- After 3 years and with an increased cumulative incidence of 7.16% versus 1.50% (RR = 4.78; 95% CI, 4.66-4.89; P < 0.0001).
- There was also a significantly higher incidence of DED requiring treatment among those who had CPCs after 3 years (0.79% vs. 0.3%; RR = 2.60; 95% CI, 2.45-2.75).
- In a multivariate Cox regression, CPCs were associated with the probability of developing DED (HR = 4.85; 95% CI, 4.76-4.94; p < 0.0001). The results remained the same when validated.
The above findings indicate that chronic pain disorders show a clear link to an increased incidence of DED cases requiring treatment through prescription. The study findings provide a good basis for considering a history of chronic pain during an ophthalmological evaluation and in assessing the risk of DED. Using the concept of systemic pain regulation in understanding difficult-to-treat dry eye can enhance patient treatment and management.
Reference:
Berzack, S., Shmushkevich, S. B., Zhang, C., Felix, E. R., De Lott, L. B., & Galor, A. (2026). Risk of Incident Dry Eye Disease Among Patients with Chronic Pain Conditions. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2026.07.025
