Prevalence and risk factors of dry eye in 79,866 participants of the population-based Lifelines cohort study in the Netherlands

Ocul Surf. 2021 Jan;19:83-93. doi: 10.1016/j.jtos.2020.04.005. Epub 2020 May 4.


Purpose: To investigate the prevalence of dry eye among all adult age categories and to discover independent risk factors by investigating a wide range of etiological categories.

Methods: A cross-sectional association study including 79,866 voluntary participants aged 20-94 years of the population-based Lifelines Cohort Study in the Netherlands.

Results: Overall, 9.1% of participants had dry eye disease as measured by the Women's Health Study dry eye questionnaire. Prevalence of dry eye symptoms were particularly prevalent in 20-30 years olds. Dry eye was associated with comorbidities in almost all body systems, including musculoskeletal, gastro-intestinal, ophthalmic, autoimmune, psychiatric, pain, functional, dermatological and atopic disorders. Numerous independent risk factors were discovered or confirmed, with strong associations for female sex, contact lens use, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, eye surgery including cataract and laser refractive surgery, keratoconus, osteoarthritis, connective tissue diseases, atherosclerosis, Graves' disease, autistic disorder, depression, 'burnout', Crohn's disease, sarcoid, lichen planus, rosacea, liver cirrhosis, sleep apnea, sinusitis, thyroid function, and air pollution (NO2). High blood pressure and high BMI were strongly associated with less dry eye, as was current smoking, while ex-smokers had more dry eye. No clear link between dry eye and lipid or blood glucose levels was found.

Conclusions: This study on dry eye confirmed but also refuted many risk factors from smaller epidemiological studies, and discovered numerous new risk factors in multiple etiological categories. The finding that dry eye symptoms are particularly common in young adults is concerning, and warrants further study.

Keywords: Autoimmune; Dry eye; Epidemiology; Pain; Prevalence; Risk factor; Sjögren syndrome; Smoking.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Cross-Sectional Studies
  • Dry Eye Syndromes* / epidemiology
  • Dry Eye Syndromes* / etiology
  • Female
  • Humans
  • Netherlands / epidemiology
  • Prevalence
  • Risk Factors
  • Young Adult