*Article* **Association of Systemic Comorbidities with Dry Eye Disease**

**Motoko Kawashima 1,\*, Masakazu Yamada 2, Chika Shigeyasu 2, Kazuhisa Suwaki 3, Miki Uchino 1, Yoshimune Hiratsuka 4, Norihiko Yokoi 5, Kazuo Tsubota 1 and for the DECS-J Study Group**


Received: 2 June 2020; Accepted: 23 June 2020; Published: 29 June 2020

**Abstract:** We investigated the association between dry eye disease and systemic comorbidities, including dry eye subtype, quality of life (QOL) and health utility among patients with dry eye disease. This cross-sectional, observational study enrolled 449 patients with dry eye disease (386 females; mean age, 62.6 ± 15.7 [range, 21–90] years). Ophthalmic examination findings included tear film break-up time (TBUT), Schirmer I value and keratoconjunctival staining score. QOL and health utility were evaluated using the Dry Eye-Related Quality-of-Life Score (DEQS) and Human Utility Index Mark 3 (HUI-3), respectively. Background information, including systemic comorbidities, was obtained. Prevalence of systemic comorbidities was 48.8% (219/449). No significant di fference occurred between DEQS and systemic comorbidity. However, patients with dry eye disease and systemic comorbidities (depression and insomnia) exhibited significantly worse ocular surface parameters, particularly regarding TBUT, than those without. Dry eye disease with insomnia or depression comorbidity significantly correlated with friction-related diseases (including conjunctivochalasis or lid wiper epitheliopathy). A high prevalence of several systemic comorbidities occurred in patients with dry eye disease. This study shows an association between ocular signs and systemic comorbidities, particularly depression and insomnia. Ophthalmologists should be aware of patients' systemic comorbidities in the diagnosis and managemen<sup>t</sup> of dry eye disease.

**Keywords:** cross-sectional study; dry eye disease; systemic comorbidity
