Conditions associated with DED:
Dry eye disease (DED) is frequently linked to several systemic and ocular conditions, notably meibomian gland dysfunction (MGD), Sjögren’s syndrome (SS), other autoimmune disorders, and diabetes. These associations influence both the type and severity of DED.
| Condition | Mechanism/Impact on DED | Notable Findings | Ref. |
|---|---|---|---|
|
Meibomian Gland Dysfunction (MGD)
|
Leading cause of evaporative DED; alters lipid layer, increases tear evaporation, and destabilizes tear film.
|
MGD is highly prevalent in DED, especially in diabetes and autoimmune disease.
|
[23, 25]
|
|
Sjögren’s Syndrome (SS)
|
Autoimmune attack on lacrimal and salivary glands, causing severe aqueous-deficient DED; often coexists with MGD.
|
SS patients have both aqueous-deficient and evaporative DED, with more severe MGD than non-SS DED.
|
[26, 27]
|
|
Autoimmune Disorders
|
Includes rheumatoid arthritis, lupus, and others; can cause both lacrimal and meibomian gland dysfunction.
|
Autoimmune diseases are major risk factors for DED, especially the aqueous-deficient subtype.
|
[26, 27]
|
|
Diabetes (Type 1 & 2)
|
Chronic hyperglycemia leads to ocular surface changes, reduced tear production, and increased prevalence of MGD.
|
DED and MGD are more common and severe in diabetes, especially with longer disease duration and poor glycemic control.
|
[28, 29]
|
Clinical insight
MGD and DED:
MGD is the most frequent cause of evaporative DED and is also common in patients with diabetes and autoimmune diseases [23].
Sjögren’s Syndrome:
While classically causing aqueous-deficient DED, SS patients often have significant MGD, resulting in mixed DED phenotypes [26].
Autoimmune Disorders:
These can cause both types of DED, with SS being the most prominent, but also include rheumatoid arthritis and lupus [26, 27].
Diabetes:
Both type 1 and type 2 diabetes are associated with higher rates and severity of DED and MGD, especially with peripheral neuropathy and longer disease duration [28, 29].