Vitamin D deficiency is associated with dry eye syndrome: a systematic review and meta-analysis

Acta Ophthalmol. 2020 Dec;98(8):749-754. doi: 10.1111/aos.14470. Epub 2020 May 18.


A systematic review and meta-analysis was conducted to determine the association between the serum vitamin D level and dry eye. A systematic literature search was performed using the PubMed, Embase, Web of Science and Cochrane Library databases to identify clinical studies evaluating the association between vitamin D levels and dry eye. The random-effect model was used to combine the results. Possible sources of heterogeneity across studies were determined by meta-regression and sensitivity analysis. Overall, 10 studies (n = 18 919) were included. Patients with dry eye had a mean serum vitamin D level that was lower than that in healthy controls by 3.99 ng/ml (95% CI -6.57, -1.40; p = 0.002). The mean Ocular Surface Disease Index score was higher (mean difference 10.70, 95% CI 1.55-19.86; p = 0.02) and Schirmer's test without anaesthesia result was lower (mean difference 6.38 mm/5 min, 95% CI -10.48, -2.28; p = 0.002) in patients with vitamin D deficiency than in controls. Tear break-up time was comparable in the vitamin D deficiency and control groups (p = 0.15). Sensitivity analyses indicated that the results obtained were robust. This meta-analysis suggested that vitamin D deficiency is associated with worse subjective symptoms and less tear production in patients with dry eye. Vitamin D deficiency may be a risk factor for dry eye syndrome. Prospective cohort and intervention studies are warranted to determine if vitamin D has a protective role in the development of dry eye.

Keywords: dry eye; serum 25-hydroxyvitamin D3; tear break-up time; tear secretion.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Biomarkers / blood
  • Dry Eye Syndromes / blood
  • Dry Eye Syndromes / etiology*
  • Humans
  • Risk Factors
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / complications*


  • Biomarkers
  • Vitamin D