Dry eye in vitamin D deficiency: more than an incidental association

Int J Rheum Dis. 2016 Jan;19(1):49-54. doi: 10.1111/1756-185X.12727. Epub 2015 Aug 13.


Aim: The aim of this article is two-fold: (i) to demonstrate the relation between vitamin D deficiency and dry eye and impaired tear function; and (ii) to investigate the possible associations among clinical parameters of hypovitaminosis D with dry eye parameters.

Method: Fifty premenopausal women with vitamin D deficiency (serum vitamin D levels < 20 ng/mL) and 48 controls were included. Participants were assessed by Schirmer's test, tear break-up time test (TBUT), ocular surface disease index (OSDI), Stanford Health Assessment Questionnaire (HAQ), fatigue severity scale (FSS), and visual analogue scale-pain (VAS-pain).

Results: Lower scores in Schirmer's test and TBUT, and higher in OSDI were detected in patients with vitamin D deficiency than in controls (P < 0.05). FSS was negatively correlated with Schirmer's test (r = -0,29; P = 0.038) and TBUT scores (r = -0,43; P = 0.002); VAS-pain was negatively correlated with TBUT scores (r = -0.32; P = 0.023). HAQ scores showed no significant correlation with dry eye parameters (P > 0.05). Vitamin D level was negatively correlated with OSDI (r = -0.49; P < 0.001), and positively with Schirmer's test (r = 0.45; P = 0.001) and TBUT scores (r = 0.30; P = 0.029).

Conclusion: Dry eye and impaired tear function in patients with vitamin D deficiency may indicate a protective role of vitamin D in the development of dry eye, probably by enhancing tear film parameters and reducing ocular surface inflammation. Patients with vitamin D deficiency should be evaluated for dry eye syndromes.

Keywords: dry eye syndromes; fatigue; pain; quality of life; vitamin D deficiency.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Case-Control Studies
  • Diagnostic Techniques, Ophthalmological
  • Dry Eye Syndromes / diagnosis
  • Dry Eye Syndromes / etiology*
  • Dry Eye Syndromes / physiopathology
  • Eye / metabolism*
  • Female
  • Humans
  • Middle Aged
  • Pain Measurement
  • Premenopause
  • Risk Factors
  • Surveys and Questionnaires
  • Tears / metabolism*
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / complications*
  • Vitamin D Deficiency / diagnosis
  • Young Adult


  • Biomarkers
  • Vitamin D
  • 25-hydroxyvitamin D