Influence of selective serotonin reuptake inhibitors on ocular surface

Abstract

Background: Antidepressant drugs may have an effect on tear film stability. This study aimed to determine the influence of selective serotonin reuptake inhibitors, which are mostly prescribed antidepressants, on ocular surface and tear film stability.

Methods: Thirty-six patients (Group 1) and 36 healthy volunteers (Group 2) were enrolled. Group 1 comprised of depression and/or anxiety disorder patients using selective serotonin reuptake inhibitors, who were in clinical remission according to psychiatric history and questionnaires (Hamilton depression rating scale and Hamilton anxiety rating scale). All subjects underwent a detailed ophthalmological examination and the following tests were performed: corneal and conjunctival fluorescein staining and Oxford scoring, tear break-up time, Schirmer 1 test, ocular surface disease index score assessment.

Results: The mean age was 36.64 (18 to 61) years in Group 1 and 31.84 (18 to 48) years in Group 2 (p > 0.05). Male to female ratio was 0.38 in Group 1 and 0.89 in Group 2 (p > 0.05). In Group 1, 19 patients (52.8 per cent) had depression, 16 patients (44.4 per cent) had anxiety disorder and one patient (2.8 per cent) had a combination of depression and anxiety disorder. The mean tear break-up times in Groups 1 and 2 were 7.05 ± 4.86 and 12.53 ± 4.75 seconds, respectively (p < 0.001). The mean Schirmer 1 test results in Groups 1 and 2 were 14.44 ± 10.81 and 17.69 ± 10.46 mm, respectively (p > 0.05). The mean superficial punctate staining according to Oxford scale in Groups 1 and 2 were grade 0.78 ± 0.76 and grade 0.11 ± 0.32, respectively (p < 0.001). The mean ocular surface disease index scores in Groups 1 and 2 were 32.07 (zero to 75.00) and 16.31 (zero to 58.33), respectively (p < 0.001).

Conclusion: Selective serotonin reuptake inhibitor usage might affect ocular surface by affecting tear film stability and such an association should be kept in mind by both psychiatrists and ophthalmologists in clinical practice.

Keywords: drugs; dry eye; ocular surface; selective serotonin reuptake inhibitors; tear film stability.