|Year : 2019 | Volume
| Issue : 1 | Page : 6-9
Associated risk factors with the presence of the symptoms of dry eye syndrome among residents of Al Ahsa, Saudi Arabia
Majed Al-Subaie1, Abdul Sattar Khan2, Muhammad Talha Khan2
1 Department of Ophthalmology, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
|Date of Submission||18-Jan-2019|
|Date of Acceptance||09-Apr-2020|
|Date of Web Publication||13-Jul-2020|
Dr. Majed Al-Subaie
Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran 34257-7630
Purpose: Dry eye syndrome (DES) results in potential damage to the ocular surface accompanied by increased tear film osmolarity and inflammation of the ocular surface. Dry eye can be a result of different habits, chronic diseases, and some medications. Hence, we designed the study to have a rough estimation of dry eye in smokers.
Methodology: The cross-sectional study was conducted for the duration of 1 month in Al Ahsa Saudi Arabia. Data collection has been carried by a validated questionnaire “McMonnies Questionnaire V2.” Consequently, Chi-square test was performed using SPSS version 21.
Results: This study showed that females have more likely to develop DES symptoms compared to males, i.e., 51.4% and 48.6%, respectively. Among the individuals having DES symptoms, the individual who does not smoke, smoke <1 pack/day, smoke 1 pack/day, or smoke >1 pack/day, there were no significant results (P = 0.211). Moreover, individuals having DES symptoms were significantly associated with dusty and sunny weather, and perfume (P < 0.001). Individuals having DES symptoms developed eye irritation and redness from swimming in chlorinated freshwater pools having a significant association (P < 0.001). Furthermore, having DES symptoms was found to be significantly associated with eye sensitivity to smog, air conditioning, and central heating (P < 0.001).
Conclusion: This study observed a significant association of symptoms of DES with various risk factors other than smoking. Therefore, further longitudinal clinical studies will be helpful in evaluating the risk factors of DES in Al Ahsa, Saudi Arabia.
Keywords: Dry eye, Saudi Arabia, smoking
|How to cite this article:|
Al-Subaie M, Khan AS, Khan MT. Associated risk factors with the presence of the symptoms of dry eye syndrome among residents of Al Ahsa, Saudi Arabia. Albasar Int J Ophthalmol 2019;6:6-9
|How to cite this URL:|
Al-Subaie M, Khan AS, Khan MT. Associated risk factors with the presence of the symptoms of dry eye syndrome among residents of Al Ahsa, Saudi Arabia. Albasar Int J Ophthalmol [serial online] 2019 [cited 2021 Jun 13];6:6-9. Available from: https://www.bijojournal.org/text.asp?2019/6/1/6/289603
| Introduction|| |
Dry eye syndrome (DES) (AKA: keratoconjunctivitis sicca) can result in potential damage to the ocular surface accompanied by increased tear film osmolarity and inflammation of the ocular surface. Some studies observed that individuals with DES are having more visual disturbance in term of eye irritation, redness, discharge, easily fatigued eyes, blurred vision, and decrease visual acuity compared with individuals who do not have; this may be due to lack of stability of ocular surface or due to dynamic change in the tear film.,,,, There are various factors that are associated with DES such as cigarette smoking due to direct contact of the smoking fumes with the eye or due to ischemic and oxidative effects., Medical conditions such as endocrinal diseases (diabetes and thyroid), musculoskeletal diseases (gout, arthritis, and osteoporosis), and some medications such as antidepressant and aspirin have been associated with DES.,,,,,
For the purpose of detecting DES symptoms, a well-structured questionnaire designed for research purposes has been used to evaluate the presence of DES symptoms among smokers., According to some studies, up to 57% of individuals having subjective symptoms of DES are having objective signs of dry eye, Therefore, subjective assessment of DES symptoms in a large population, using a simple self-administrated questionnaire, can be very helpful for estimating the presence of DES.,,,, Furthermore, one study also found that screening of DES based on the symptoms and clinical signs helps in determining the cases better than clinical signs alone.
One study reports the prevalence of DES in Jeddah, Saudi Arabia, using a subjective questionnaire along with clinical tests and found 93.2% cases of DES. Among those cases, the leading risk factors included blepharitis followed by smoking. In order to have the baseline data since the literature on DES in Al Ahsa, Saudi Arabia is scarce, therefore, we prompt to conduct this study.
| Methodology|| |
The cross-sectional study was conducted for a duration of 1 month (September 2016) after the approval of the Ethical Committee at the King Faisal University, Al Ahsa, Saudi Arabia. We used a validated questionnaire “McMonnies Questionnaire V2” to collect the data. The questionnaire included 14 questions, with a sensitivity of 98% and specificity of 97%.,
In addition, some variables have been added such as socioeconomic status, smoking index, chronic diseases, and medication use. Furthermore, the question on alcohol consumption was deleted to accommodate social acceptance. The included individuals in this study were Saudi males and females aged above 15 years. Conversely, individuals who were exposed to occupational smokes (factory workers, constrictors, and traffic) and who had any eye surgery were omitted from this study. Convenience sampling was used for the purpose of data collection in three different shopping malls of Al Ahsa, Saudi Arabia, that facilitate the entire Al Ahsa. The data were then analyzed using a software “SPSS version 21 (IBM, USA).”
| Results|| |
From our result out of 979 scanned yielded 321 smokers, as depicted in [Table 1], this study showed significant results in terms of gender and presence of DES symptoms, with the females having more DES symptoms (51.4%) compared to males (48.6%) (P < 0.001). In terms of age and the presence of DES symptoms among different categories, there was no statistically significant difference seen in our study (P = 0.363).
|Table 1: Association of the presence of dry eye syndrome with gender and age|
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As shown in [Table 2], no significant association was observed among DES symptoms and person who does not smoke, smoke <1 pack/day, smoke 1 pack/day, and smoke >1 pack/day (P = 0.211). Consequently, DES symptoms were found to be significantly associated with dusty and sunny weather (P < 0.001), perfume smoke (P < 0.001), and irritation and eye redness developed from swimming in chlorinated freshwater pools (P < 0.001). Furthermore, DES symptoms were also found to be significantly associated with eye sensitivity to cigarette smoke, smog, air conditioning, and central heating (P < 0.001).
|Table 2: Association of the presence of dry eye syndrome with the risk factors|
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In addition, our study showed a significant association of DES symptoms with dryness experience of the nose, mouth, throat, chest, or vagina (P < 0.001). The use of vitamins, as well as the patient not visiting eye doctor, was also significantly associated with the development of DES symptoms (P < 0.001).
| Discussion|| |
No significant association was observed between DES, nonsmokers, and the number of cigarettes smoked by smokers per day; however, one study observed an association between DES and smoking rate, with heavy smokers having more chances of developing DES. Moreover, our study did not observe any association of DES with active and passive smokers, as well as with comorbidities such as diabetes and thyroid dysfunction. Similarly, different age groups were not found to be associated with DES, as in the case of another study that observed the association between DES prevalence and age.
This study observed more prevalence of DES among women as compared to men, despite the fact that smoking is more prevalent in men. This is in line with another study, which showed two-third of participants who suffered from DES were women. A convincing reason for this could be a hormonal imbalance among women, resulting in meibomian gland dysfunction (MGD). The evaporative dry eye due to MGD is considered to be a most common subtype of DES, as shown by some cohort studies.,,,,,,
Weather is considered to be a risk factor for DES, especially in the low humid environment. The weather of Al Ahsa is also less humid; probably, because of this reason, our study resulted in a significant association between dusty weather and sun exposure. Nevertheless, it is not certain that the observed DES is solely because of changes in weather or may be due to other confounding factors such as environmental pollution. Interestingly, an association of DES with the use of perfumes and neglecting doctor visit by individuals who have increased symptoms have been seen in our study.
In addition to dry mouth, which is considered to be a most common risk factor of DES, our study also found a significant association with experiences of other dryness symptoms such as dryness of the vagina, which is consistent with another study. Similarly, this study also observed a significant association of DES and swimming in chlorinated pools, which was a similar finding of one study. However, the findings of this study were in contrast with a study conducted in Mexico that did not show a significant association between DES with indoor and outdoor hazards, i.e., air conditioning and central heating and smoke and smog, respectively. Likewise, we found a significant association between DES and the use of multivitamins, which differed from the finding of a similar study.
This study is limited to a snapshot of DES prevalence, which could vary during a year, because of the cross-sectional design of the study. The data of this study were based on self reported questionnaire of DES symptoms with high senstivity and specifity although it can be less valid than an objective clinical assessment.
| Conclusion|| |
Dry eye is a common chronic eye condition that reduces the quality of life by causing eye discomfort and vision issues. This study did not observe any significant association of DES with smoking. Therefore, further longitudinal clinical studies will be helpful in evaluating the risk factors of DES in Al Ahsa, Saudi Arabia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lemp M. The definition and classification of dry eye disease: Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:75-92.
Montés-Micó R, Cáliz A, Alió JL. Changes in ocular aberrations after instillation of artificial tears in dry-eye patients. J Cataract Refract Surg 2004;30:1649-52.
Ridder WH 3rd
, Tomlinson A, Huang JF, Li J. Impaired visual performance in patients with dry eye. Ocul Surf 2011;9:42-55.
Rieger G. The importance of the precorneal tear film for the quality of optical imaging. Br J Ophthalmol 1992;76:157-8.
Yokoi N, Yamada H, Mizukusa Y, Bron AJ, Tiffany JM, Kato T, et al
. Rheology of tear film lipid layer spread in normal and aqueous tear-deficient dry eyes. Invest Ophthalmol Vis Sci 2008;49:5319-24.
Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea 2004;23:272-85.
Schein O, Muñoz B, Tielsch J, Bandeen-Roche K, West S. Prevalence of dry eye among the elderly. Am J Ophthalmol 1997;124:723-8.
Yoon KC, Song BY, Seo MS. Effects of smoking on tear film and ocular surface. Korean J Ophthalmol 2005;19:18-22.
Kaido M, Dogru M, Yamada M, Sotozono C, Kinoshita S, Shimazaki J, et al
. Functional visual acuity in Stevens-Johnson syndrome. Am J Ophthalmol 2006;142:917-22.
Bergmann MT, Newman BL, Johnson NC Jr., The effect of a diuretic (hydrochlorothiazide) on tear production in humans. Am J Ophthalmol 1985;99:473-5.
Norn MS. Outflow of tears and its influence on tear secretion and break up time (B.U.T.). Acta Ophthalmol (Copenh) 1977;55:674-82.
Methodologies to Diagnose and Monitor Dry Eye Disease: Report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:108-52.
Sargent C, Ludlow M, McCredie M, Brooks PM, Webb J. Assessment of a patient-completed questionnaire for keratoconjunctivitis sicca. Med J Aust 1988;148:395-8.
Sullivan D, Dartt DA, Meneray MA. Lacrimal Gland, Tear Film, and Dry Eyes 2. 1st
ed. New York, NY [U.A.]: Plenum; 1998.
Pflugfelder SC, Tseng SC, Sanabria O, Kell H, Garcia CG, Felix C, et al
. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 1998;17:38-56.
Hay EM, Thomas E, Pal B, Hajeer A, Chambers H, Silman AJ. Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: Results from a population based study. Ann Rheum Dis 1998;57:20-4.
Tomlinson A, Pearce EI, Simmons PA, Blades K. Effect of oral contraceptives on tear physiology. Ophthalmic Physiol Opt 2001;21:9-16.
Versura P, Cellini M, Torreggiani A, Profazio V, Bernabini B, Caramazza R. Dryness symptoms, diagnostic protocol and therapeutic management: A report on 1,200 patients. Ophthalmic Res 2001;33:221-7.
Anderson JA, Whaley K, Williamson J, Buchanan WW. A statistical aid to the diagnosis of keratoconjunctivitis sicca. Q J Med 1972;41:175-89.
Gothwal V, Pesudovs K, Wright T, McMonnies C. McMonnies Questionnaire: Enhancing screening for dry eye s with rasch analysis. Invest Opthalmol Vis Sci 2010;51:1401.
Viso E, Rodriguez-Ares MT, Gude F. Prevalence of and associated factors for dry eye in a Spanish adult population (the Salnes Eye Study). Ophthalmic Epidemiol 2009;16:15-21.
Christensen JL. History of the Journal of the American Optometric Association. J Am Optom Assoc 1985;56:852-8.
Mathers WD, Lane JA, Zimmerman MB. Tear film changes associated with normal aging. Cornea 1996;15:229-34.
Martinez JD, Galor A, Ramos-Betancourt N, Lisker-Cervantes A, Beltrán F, Ozorno-Zárate J, et al
. Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City. Clin Ophthalmol 2016;10:1335-42.
Uchino M, Yokoi N, Uchino Y, Dogru M, Kawashima M, Komuro A, et al
. Prevalence of dry eye disease and its risk factors in visual display terminal users: The Osaka study. Am J Ophthalmol 2013;156:759-66.
Tong L, Chaurasia SS, Mehta JS, Beuerman RW. Screening for meibomian gland disease: Its relation to dry eye subtypes and symptoms in a tertiary referral clinic in singapore. Invest Ophthalmol Vis Sci 2010;51:3449-54.
Yoon KC, Song BY, Seo MS. Effects of smoking on tear film and ocular surface. Korean J Ophthalmol 2005;19:18.
Altinors DD, Akça S, Akova YA, Bilezikçi B, Goto E, Dogru M, et al
. Smoking associated with damage to the lipid layer of the ocular surface. Am J Ophthalmol 2006;141:1016-21.
Lee SY, Petznick A, Tong L. Associations of systemic diseases, smoking and contact lens wear with severity of dry eye. Ophthalmic Physiol Opt 2012;32:518-26.
[Table 1], [Table 2]