Patient temperament — especially depression and anxiety — are associated with signs and symptoms of dry eye disease, according to research published in Journal français d’ophtalmologie.

Researchers evaluated the relationship between DED symptoms and objective findings and the personalities and levels of depression and anxiety in patients with DED at a single ophthalmology clinic. 

All patients underwent a complete ophthalmologic examination, including tear-film break-up time (TBUT), Schirmer 1, and Ocular Surface Disease Index (OSDI), and completed the Temperament and Character Inventory, Beck Depression Inventory, and Beck Anxiety Inventory.

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The study included a total of 67 patients with DED (71.6% women and 28.4% men; mean age, 48.9±10.68 years). Additional systemic disease was reported for 29.9% of patients (rheumatological diseases, 14.9%; hypertension, 10.4%; and diabetes 4.5%). Participants were categorized into 4 dimensions of patient temperament: novelty seeking, harm avoidance, reward dependence and persistence.

The researchers found no relationship between the Schirmer 1 and TBUT tests and psychological parameters or OSDI scores. 

When comparing the patients’ values with normal values for a reference population (n=683), they found sub-dimensions of temperament were significantly different. They observed lower novelty seeking (15.3 vs 18.5; P <.001) as well as higher harm avoidance (18.8 vs 16.8; P =.014) and persistence (5.8 vs 4.8; P <.001) in the patient group compared with the reference group.

The team found OSDI results were positively correlated with harm avoidance (P =.041) and negatively correlated with novelty seeking (P =.047). Using a mediation model, they demonstrated that anxiety mediated the effect of novelty seeking and harm avoidance on OSDI.

“The significant association of temperament sub-dimensions with OSDI scores in the DED group may play a role in explaining the inconsistency between symptoms and signs,” the researchers report. “Careful and comprehensive assessment of patients’ mental status needs to be integrated into DED management to help tailor treatment to patient needs.” 

Limitations of the study included the relatively small number of patients, use of only the Schirmer 1 and TBUT tests as objective tests, and inability to determine the direction of the relationship or its causality between clinical evaluations and scale scores due to the cross-sectional nature of the study.


Kuru T, Öktem Ç, Öktem EÖ, Aslan F. The role of temperament in evaluating the relationship between symptoms and signs in dry eye diseaseJ Fr Ophtalmol. Published online February 4, 2023. doi:10.1016/j.jfo.2022.09.030

This article originally appeared on Ophthalmology Advisor