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Dry eye incidence


Dry eye syndrome is common in older people, and affects quality of life. Until recently there have been no longitudinal population-based studies that might inform on the likely incidence in a primary care adult population. We now have one [1], and we can say that in people aged 48 to 91 years, 13% will develop dry eye over five years.


Beaver Dam in Wisconsin is the site of a population based eye study that began in 1988. Almost 6,000 adults were then aged 43 to 84 years, and were examined initially and followed up in the years 1988-1990, 1993-1995 and 1998-2000.

Dry eye information was first collected in 1993-1995, when 2,414 people were examined and found not to have dry eye syndrome. At the next examination in 1998-2000 the presence of dry eye, or history of dry eye in the intervening years was established, so that the five-year incidence of dry eye could be established.

Dry eye was determined by a positive response to the question:

“For the past 3 months or longer, have you had dry eyes?”

For participants needing further prompting, dry eye was described as “foreign-body sensation with itching and burning, sandy feeling, not related to allergy”. Considerable additional information relating to demographics and drug history was collected in addition, and used to examine associations with dry eye.


Of the 2,414 participants who did not have dry eye at the baseline in 1993-1995, 56% were women, and the age range was 48 to 91 years. Almost every participant was white. During the five years, 322 adults developed dry eye, a five year incidence of 13% and an annual incidence of 2.7%.

Dry eye incidence increased with age (Figure 1), and was slightly higher in women (15%) than men (12%). Incidence was higher with a history of allergy and antihistamine use, but also with use of diuretics and steroids, and with poorer self-rated health status (Figure 2). It was lower in people using ACE-inhibitors.

Figure 1: Five year incidence of dry eye in adults, according to age

Figure 2: Five year incidence of dry eye in adults, according to self-reported health status


Dry eye is one of those quite common conditions that seems a bit of a mystery. This study is useful in that it provides one solid piece of information from a good study that we can probably trust. The reasons for trusting it include the fact that it was large, conducted over a long period, as part of detailed study of eye disease, and from a defined population rather than a special population, like a clinic or people with a particular disease.

The most useful features are that it gives us a number (almost 3% of older adults will develop dry eye each year), and tells us that it will be more frequent in those with poor health status or who are older (often much the same thing). The association with allergy and antihistamines is probably to be expected, and the relationships of either direction between use of antihistamines, diuretics and ACE inhibitors, while statistically significant, are not of sufficient size to worry about. Bandolier will look for evidence about treating dry eye syndrome.


  1. SE Moss et al. Incidence of dry eye in an older population. Archives of Ophthalmology 2004 122: 369-373.

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