High Prevalence of Dry Eye Across Autoimmune Diseases Beyond Sjögren’s: JAMA
A population-based study from Taiwan has evaluated the occurrence of dry eye across multiple autoimmune diseases. While dry eye is a hallmark feature of Sjögren’s disease, the study found that it also affects 20%–40% of patients with other autoimmune conditions. Dry eye was more commonly observed in individuals whose autoimmune disease was diagnosed later in life, highlighting that dry eye is a frequent and underrecognized manifestation across a broad spectrum of autoimmune disorders. The study was published in JAMA Network Open by Nan-Ni Chen and fellow researchers.
Dry eye disease affects 5% to 40% of adults over 40 years of age in Taiwan. It is considered the most common ocular manifestation of autoimmune diseases, which affects 10% to 95% of those with autoimmune diseases. Autoimmune dry eye includes aqueous-deficient and evaporative dry eye and is considered to be of more severe inflammation and symptoms than nonautoimmune dry eye. However, its specific prevalence, onset, and severity of dry eye disease have been poorly characterized.
The present study is a cohort study based on data from the Taiwan National Health Insurance Research Database from 2008 to 2021, which covers more than 99% of the population. The study used data from the Registry for Catastrophic Illness Patients and included 10 major autoimmune diseases. The study included 67,264 patients who had been newly diagnosed with autoimmune disease from 2011 to 2020.
The study was conducted in accordance with the STROBE statement. The level of statistical significance was set at a 2-sided P < 0.05. Ethical approval was granted for the study, and the requirement for informed consent was waived.
Key findings:
Among the 67,264 patients, rheumatoid arthritis was found to be the most common autoimmune disease, with 24,595 (36.6%) patients affected, followed by Sjögren syndrome, which affected 23,088 (34.3%) individuals.
In addition, the prevalence of dry eye disease differed significantly among autoimmune diseases. Sjögren syndrome had the highest prevalence of dry eye disease, with 18,766 (81.3%) out of 23,088 patients affected, while Crohn disease had the lowest prevalence of 309 (23%) out of 1,346 patients.
It was also found that dry eye disease was more common in females compared to males for all autoimmune diseases.
In addition, it was found that keratitis and corneal ulcer were more common in Sjögren syndrome, with 7,097 (30.7%) cases of keratitis and 766 (3.3%) cases of corneal ulcer, compared to rheumatoid arthritis, which had 5,299 (21.6%) cases of keratitis and 727 (3%) cases of corneal ulcer.
In systemic lupus erythematosus, 2,320 (23.8%) out of 9,715 patients developed keratitis, while 279 (2.9%) developed corneal ulcer. In addition
Progression from dry eye disease to more severe complications differed significantly among diseases. Vasculitis showed the highest proportion of progression among dry eye patients, with 94 of 341 patients (27.6%) developing keratitis and 36 of 341 (10.6%) developing corneal ulcer.
Dry eye disease typically precedes autoimmune diagnosis by approximately 3 years across conditions. Patients with dry eye were diagnosed with autoimmune diseases at significantly older ages than those without dry eye.
The largest age difference was seen in Crohn disease, where patients with dry eye had a mean age of 53.57 ± 18.00 years compared with 39.57 ± 15.66 years among those without dry eye (t = –10.51; P < 0.001).
In this Taiwanese national cohort of 67,264 patients, dry eye disease had a high prevalence among autoimmune diseases, such as Sjögren's syndrome. In addition, it had high rates of pre-existing cases before the diagnosis of autoimmune diseases, with approximately 3 years preceding diagnosis. The progression of keratitis and corneal ulcers had high rates in vasculitis, rheumatoid arthritis, and systemic lupus erythematosus. These facts emphasize that dry eye disease can be an early systemic sign.
Reference:
Chen N, Huang Y, Sun C. Epidemiology of Dry Eye in Patients With Autoimmune Disease. JAMA Netw Open. 2026;9(2):e2560275. doi:10.1001/jamanetworkopen.2025.60275
