Dry Eye Disease After Refractive Surgery.

Background Dry eye is among the most prevalent complications following refractive surgery, significantly impacting the training and daily lives of recruits. While recent years we have witnessed some advancements in understanding the occurrence and progression of dry eye, the specific effects of refractive surgery on this condition remain unclear. This study aims to investigate the impact of refractive surgery on dry eye among 300 army recruits. Methods A series of examinations specific to dry eye were conducted on the subjects using the OSDI questionnaire and the ocular surface comprehensive analyzer. The correlation between refractive surgery and dry eye was analyzed in conjunction with dry eye symptoms and related data. Additionally, optical coherence tomography (OCT) was employed to observe fundus changes in dry eye patients, comparing those with low to moderate myopia against patients with high myopia prior to surgery. The morphology of the meibomian glands in the upper eyelid was assessed using the Keratograph 5M ocular surface analyzer, where the area of meibomian gland loss was calculated and scored, facilitating an exploration of the relationship between meibomian gland loss and dry eye. Furthermore, the dry eye detection rates of Non-Invasive Break-Up Time (NIBUT), Lipid Layer Thickness Measurement (LTMH), and basal Schirmer secretion (SIT) were calculated, and the diagnostic differences among these three methods for dry eye were analyzed. Results According to the OSDI questionnaire, 117 (39%) patients opted for SMILE, 60 (20%) for F-LASIK, and 123 (41%) for LASIK. Among the recruits, 78 (26%) were diagnosed with dry eye following refractive surgery. Single factor and multiple logistic regression analyses indicated that LASIK may serve as an independent risk factor for the development of dry eye after refractive surgery. Furthermore, the incidence of leopard-pattern fundus was significantly higher in recruits with high myopia compared to those with low to moderate myopia. Keratograph5M assessments revealed that 52.6% of patients exhibited no meibomian gland loss; 45.5% had meibomian gland loss of less than 1/3; 1.9% experienced meibomian gland loss ranging from 1/3 to 2/3; and no patients had meibomian gland loss exceeding 2/3. These results suggest that there is no direct relationship between dry eye and meibomian gland loss following refractive surgery. Additionally, the dry eye detection rate using non-invasive tear break-up time (NIBUT) was 92.6%, while the detection rate for LTMH dry eye was 91.0%. The basal Schirmer test (SIT) yielded a dry eye detection rate of 78.2%, indicating that non-invasive tear assessment methods have a higher detection rate for dry eye. Conclusions The incidence of dry eye among recruits following excimer laser corneal refractive surgery is significantly higher than that observed with other surgical methods, suggesting that it may represent an independent risk factor for dry eye post-refractive surgery. Consequently, we do not recommend the use of laser in situ keratomileusis for refractive surgery.

Dry eye is among the most prevalent complications following refractive surgery, significantly impacting the training and daily lives of recruits. While recent years we have witnessed some advancements in understanding the occurrence and progression of dry eye, the specific effects of refractive surgery on this condition remain unclear. This study aims to investigate the impact of refractive surgery on dry eye among 300 army recruits. A series of examinations specific to dry eye were conducted on the subjects using the OSDI questionnaire and the ocular surface comprehensive analyzer. The correlation between refractive surgery and dry eye was analyzed in conjunction with dry eye symptoms and related data. Additionally, optical coherence tomography (OCT) was employed to observe fundus changes in dry eye patients, comparing those with low to moderate myopia against patients with high myopia prior to surgery. The morphology of the meibomian glands in the upper eyelid was assessed using the Keratograph 5M ocular surface analyzer, where the area of meibomian gland loss was calculated and scored, facilitating an exploration of the relationship between meibomian gland loss and dry eye. Furthermore, the dry eye detection rates of Non-Invasive Break-Up Time (NIBUT), Lipid Layer Thickness Measurement (LTMH), and basal Schirmer secretion (SIT) were calculated, and the diagnostic differences among these three methods for dry eye were analyzed. According to the OSDI questionnaire, 117 (39%) patients opted for SMILE, 60 (20%) for F-LASIK, and 123 (41%) for LASIK. Among the recruits, 78 (26%) were diagnosed with dry eye following refractive surgery. Single factor and multiple logistic regression analyses indicated that LASIK may serve as an independent risk factor for the development of dry eye after refractive surgery. Furthermore, the incidence of leopard-pattern fundus was significantly higher in recruits with high myopia compared to those with low to moderate myopia. Keratograph5M assessments revealed that 52.6% of patients exhibited no meibomian gland loss; 45.5% had meibomian gland loss of less than 1/3; 1.9% experienced meibomian gland loss ranging from 1/3 to 2/3; and no patients had meibomian gland loss exceeding 2/3. These results suggest that there is no direct relationship between dry eye and meibomian gland loss following refractive surgery. Additionally, the dry eye detection rate using non-invasive tear break-up time (NIBUT) was 92.6%, while the detection rate for LTMH dry eye was 91.0%. The basal Schirmer test (SIT) yielded a dry eye detection rate of 78.2%, indicating that non-invasive tear assessment methods have a higher detection rate for dry eye. The incidence of dry eye among recruits following excimer laser corneal refractive surgery is significantly higher than that observed with other surgical methods, suggesting that it may represent an independent risk factor for dry eye post-refractive surgery. Consequently, we do not recommend the use of laser in situ keratomileusis for refractive surgery.

Dry Eye Disease: The Clinician’s Guide to Diagnosis and Treatment Penny A. Asbell and Michael A. Lemp, New York, Thieme; 2006. $139.95. Two of the most well known names in the field of dry eye disease have put together this remarkable book on the diagnosis and treatment of one of the most common diseases encountered in caring for patients and their eyes. It is a slim volume at just over 200 pages and consequently not too onerous to pick up and carry around. Within these 200 pages are eighteen chapters, each penned by a group of one to three experts who have helped contribute to our contemporary understanding of this complex disease. Each chapter begins with a bulleted listing of “key points” to help the reader quickly focus in on the most salient issues. The chapters are subdivided into meaningful sections that assist in finding the desired information. And there is a wealth of information reviewed in each chapter. The information is enhanced by the inclusion of numerous tables and figures, with some chapters including several descriptive color photographs. Its organization generally allows the reader rapid access to information on the performance of clinical diagnostic tests and treatment options, in both cases covering the old standbys as well as more novel approaches. It discusses dry eye disease in the context of lid disease, contact lens wear, refractive surgery, and systemic disease. Overall it is an excellent resource for students and seasoned clinicians that provides a thorough review of current understandings of dry eye disease diagnosis and treatment options through the eyes of some highly respected experts. The book begins with a two chapters reviewing the epidemiology of dry eye disease and its pathogenesis. The next three chapters are devoted to the diagnosis of dry eye using questionnaires, in-office diagnostic tests, and an interesting summary of a number of potentially useful newer tests that have yet to find their way into most clinics. You will then find a chapter on the diagnosis and management of meibomian gland disease and following that, four chapters on treatments for dry eye disease covering tear replacement strategies, modulation of inflammation and immunity, complementary and alternative medicine approaches, and mucin stimulation and hormonal treatments. The next chapters are devoted to dry eye disease in the context of contact lens wear and refractive surgery, the diagnosis and treatment of severe dry eye disease, and a description of surgical approaches including the use of punctal plugs as well as more invasive approaches that are used in the management of severe lid and ocular surface disorders. A chapter on dry eye in the context of systemic issues provides a fairly detailed guide to Sjogren’s Syndrome and aqueous deficient dry eye, and brief discussions of sex hormones, graft-versus-host disease, Stevens-Johnson syndrome, and pseudo-pemphigoid. The final three chapters are aimed at passing along lessons learned from clinical trials in dry eye disease, keeping current on medical information and drug development for dry eye disease, and providing a peek at what the future might hold. The book is far more detailed than a straightforward clinical “guide” and accordingly I think it will find its use more in the context of a usefully thorough and informed reference on dry eye disease from its milder forms through its most severe. It is not a simple step-by-step guide to take you from the moment the dry eye patient sits down in your chair to when they leave your office with a diagnosis and treatment plan. That is not to say that such information is not in the book. It is. For example, Chapter 4 contains not only fairly in-depth descriptions of the most commonly used diagnostic tests including pictorial descriptions of surface staining grading systems, but also a recommended ordering for the conduct of such tests for a routine dry eye examination. It might have been nice to have some of the most clinically useful information also available on little note-sized cards to pull out and tack up on the wall for easy reference on the fly. Nevertheless, having such a thorough discussion of dry eye and all of its nuances together in one tidy volume should help any clinician who manages patients with dry eye disease. A little disappointing to me is the timing of the book’s release at just about the same moment as the publication of the full report of the International Dry Eye Workshop (DEWS; Ocular Surface, 2007). Thus, readers will not find the newest definition of dry eye disease and some other information that became available with the publication of the DEWS report. This is a common issue affecting books in general, but there are advantages to the book too. Whereas the DEWS report represents a consensus view derived from the efforts of a large group of international experts, here each author has had more leeway to emphasize his/her own point of view. The book does a nice job of emphasizing the evolution in our understanding of dry eye disease, its complexity, and its importance to our patients. It is written for the clinician by clinicians, but ultimately, I hope that our patients would be the biggest beneficiaries of the book as more clinicians gain a broader and more evidence-based understanding of how to diagnose and effectively manage this very common and troubling eye disease. Debra A. Schaumberg Brigham and Women’s Hospital Harvard Medical School Boston MassachusettsFigure

Dry eye disease (DED) is a chronic ocular surface condition that affects millions of people and has a worldwide prevalence of over 50%. Morbidities associated with DED include pain, discomfort, and blurring of vision. DED has evolved into a pressing public health concern due to the economic and psychosocial burden it imparts on affected individuals. A multitude of etiological or risk factors has been identified, ranging from aging, surgery, and malnutrition to occupational environment. These factors contribute to ocular surface inflammation, epitheliopathy, hyperosmolarity, tear film instability, and neurosensory abnormalities that culminate in the presentation of signs and symptoms of DED. Aberrant and chronic ocular surface inflammation emerged as a key modifiable contributor in DED pathobiology due to its direct association with signs and symptoms of DED, and resolution of disease following the use of anti-inflammatory agents. Despite being one of the most successful therapeutic strategies in DED management, there is a substantial number of patients who are refractory to anti-inflammatory regimen and other current forms of treatment. In addition, complexity in the management of DED increases with the presence of discordance between signs and symptoms in some patients. Hence, there is an urgent and constant need to identify additional disease mechanisms and contributors that can be targeted to resolve the morbidities associated with DED. The current special issue DED is designed to report and highlight the various translational investigations that have been directed towards improving DED management in clinical practice. These include (i) disease-specific and biomarker-based stratification of patients for personalized treatment and prevention of disease progression; (ii) newer therapeutic strategies that include both pharmacological and non-pharmacological (such as thermal pulsation therapy) approaches; (iii) novel molecular factors and mechanisms including novel proteins, interferon imbalance and ionic imbalances; (iv) physiological variations, such as hormonal and nutritional changes; (iv) newer disease models, including animal models that can be used to understand newer mechanisms and to test emerging and novel therapeutic agents. In summary, the contributors to this special issue have provided critical additions to the DED knowledgebase, with reference to both pathological mechanisms and clinical management. About the AuthorDr. Rohit Shetty Dr. Rohit Shetty is the Vice Chairman of Narayana Nethralaya, Bangalore, a cornea-refractive surgeon and a clinician scientist with a keen interest in keratoconus, corneal ectatic disorders and dry eye disease. He has been practicing high volume refractive surgery for 15 years now. Dr Shetty obtained his FRCS Glasgow in 2006 and is currently an FRCS examiner. He is the Chief Mentor for the Dual Academic Program (PhD & Clinical Fellowship) at Narayana Nethralaya Eye Institute, Bangalore and Maastricht University. He was recently awarded the Fellowship of the American College of Surgeons. Dr Shetty has close to 350 publications in peer-reviewed journals and is a reviewer for many indexed journals in the specialty. He is also on the editorial board of the Journal of Refractive Surgery. With a keen interest in imaging, some of his research includes, waveform analysis of deformation and deflection amplitude in keratoconus, influence of ocular spherical aberration on near and intermediate visual acuity in presbyopic eyes, biomechanics of LASIK Flap and SMILE Cap and corneal tomography in post-refractive surgery ectasia. In the 2015 annual conference of the All India Ophthalmological Society, Dr Shetty won the prestigious Col. Rangachari Award for his work on "Is Inflammation Driving Keratoconus? A Holistic Study of Molecular Pathways". The American Academy of Ophthalmology recently conferred the Achievement Award to Dr Rohit Shetty for distinguished services rendered over the years to the programs of the society. Besides being conferred the Casebeer Award for outstanding contribution to refractive surgery, he was recently awarded the Achievement Award by the Asia-Pacific Academy of Ophthalmology.

Seeing through tears: Understanding and managing dry eye disease.

Objective To study the risk factors of dry eye disease (DED) in the north of Shannxi Province. Methods A case-control study data of 147 patients with DED and 162 patients free-DED were analyzed using logistic regression. Results Univariate analysis showed that the constitu-ent ratio of long-term outdoor, long-term video, local administration, history of eye disese and alcohol consumption were higer on patients with DED than that in controls (P <0.05) .Logistics regression analysis showed that the constituent ratio of long-term outdoor, long-term video, local administration, history of eye diseases were independent risk factors for DED. Conclusions Long-term outdoor, long-term video, local administration, history of eye disease are risk factors for DED in the north of Shannxi Province. Key words: dry eye; risk factor; north of Shan xi Province

Purpose. To analyze the corneal indices obtained during examination with the Corvis® ST device of myopic patients — candidates for laser refractive surgery with dry eye syndrome (DES), before and after its treatment.Patients and methods. Study group I consisted of 88 patients with mild to moderate dry eye syndrome according to the classification of the International Seminar on Dry Eye Syndrome (TFOS DEWS II Definition and Classification Report), group II — 88 patients with no signs of corneal-conjunctival xerosis with complex myopic astigmatism at the age of 18 to 45 years (29.01 ± 7.68). The study of biomechanical parameters of the patients’ cornea was carried out using Corvis® ST (Oculus, Germany).Results. During the initial examination, six out of ten biomechanical indicators (DAM, A1T, A1V, A2T, A1L, SP_A1) in patients of study group I were significantly different (p &lt; 0.05) from the indicators of study group II, the rest (A2V, A2L, HC_time, PD) were comparable (p &gt; 0.05). Complex indices CBI, BAD_D in patients with DES were also statistically significantly (p &lt; 0.05) different from those of patients without signs of DES and did not change after treatment for DES (p &gt; 0.05). During the initial examination of patients in group I, 37 patients (42 %) had TBI in the range of 0.5–0.9. Against the background of conservative treatment of dry eye syndrome, the number of such patients decreased to 20 (22 %), and with a TBI level of up to 0.3 it increased to 30 (34 %).Conclusion. The values of corneal biomechanical parameters determined during examination on Corvis® ST in patients with dry eye syndrome are different from those of patients without symptoms of corneal-conjunctival xerosis. Improving the condition of the ocular surface against the background of drug correction of dry eye syndrome and, as a result, improving the TBI index, provides a better selection of patients for laser refractive surgery and the choice of method for its implementation. The influence of asymptomatic dry eye syndrome in a significant number of patients on the value of corneal parameters studied on Corvis® ST determines the need for preventive diagnosis of dry eye disease in the general algorithm for examining all patients before refractive surgery.

Dry Eye Disease after Refractive Surgery: Comparative Outcomes of Small Incision Lenticule Extraction versus LASIK

Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.

Actuality. Today, laser correction of refractive errors is a high-tech and safe industry in ophthalmic surgery, which provides highly predictable and stable refractive results in patients with ametropia. But at the same time, keratorefractive surgery can cause the development of induced dry eye syndrome, which will be one of the main reasons for dissatisfaction with the result of surgery in patients. Even a mild form of dry eye syndrome can significantly affect a patient's quality of life, leading to decreased performance. Purpose. To study the data of modern literature sources on the main aspects of etiopathogenesis and diagnosis of dry eye syndrome in refractive patients. Material and methods. To perform the review, we analyzed the search for literature sources on PubMed reference databases using the keywords «tear film», «dry eye syndrome», «keratorefractive surgery» according to Russian publications on the subject of the article for the period up to and including 2025. Results and discussion. An important basis for understanding dry eye syndrome is not only the etiology of the pathogenesis of the disease, but also the conduct of a qualitative diagnosis followed by ensuring the comfort of visual functions in patients with refractive profile. Conclusion. Identifying patients at risk of developing dry eye syndrome after refractive surgery allows the ophthalmologist to take the necessary measures to optimize the condition of the eye surface before surgery, which helps to obtain a portrait of a happy refractive patient. Key words: tear film, ocular surface, dry eye syndrome, keratorefractive surgery.

BackgroundDry eye disease (DED) predominantly results from elevated tear film osmolarity, which can not only cause ocular inconvenience but may lead to visual impairments, severely compromising patient well‐being and exerting substantial economic burdens as well. Astaxanthin (AST), a member of the xanthophylls and recognized for its robust abilities to combat inflammation and oxidation, is a common dietary supplement. Nonetheless, the precise molecular pathways through which AST influences DED are still poorly understood.MethodsTherapeutic targets for AST were identified using data from the GeneCards, PharmMapper, and Swiss Target Prediction databases, and STITCH datasets. Similarly, targets for dry eye disease (DED) were delineated leveraging resources such as the Therapeutic Target Database (TTD), DisGeNET, GeneCards, and OMIM databases, and DrugBank datasets. Interactions among shared targets were charted and displayed using CytoScape 3.9.0. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted to elucidate the functions of pivotal targets within the protein–protein interaction network. Molecular interactions between AST and key targets were confirmed through molecular docking using AutoDock and PyMOL. Molecular dynamics simulations were performed using GROMACS 2022.3. Viability of human corneal epithelial cells (hCEC) was assessed across varying concentrations of AST. A mouse model of experimental DED was developed using 0.1% benzalkonium chloride (BAC), and the animals were administered 100 mg/kg/day of AST orally for 7 days. The efficacy of the treatments was assessed through a series of diagnostic tests to evaluate the condition of the ocular surface after the interventions. The levels of inflammation and oxidative stress were quantitatively assessed using methods such as reverse transcription‐polymerase chain reaction (RT‐PCR), Western blot, and immunofluorescence staining.ResultsNetwork pharmacology suggests that AST may alleviate DED by influencing oxidation–reduction signaling pathways and reducing oxidative stress provoked by BAC. In vivo experiments demonstrated an improved overall condition in AST‐administered mice in contrast to the control group. Immunofluorescence staining analyses indicated a decrease in Keap1 protein in the corneal tissues of AST‐treated mice and a significant increase in Nrf2 and HO‐1 protein. In vitro studies demonstrated that AST significantly enhanced cell viability and suppressed reactive oxygen species expression under hyperosmotic (HS) conditions, thereby protecting the human corneal epithelium.ConclusionAST is capable of shielding mice from BAC‐induced DED, decelerating the progression of DED, and mitigating oxidative stress damage under HS conditions in hCEC cells. The protective impact of AST on DED may operate through stimulating the Keap1‐Nrf2/HO‐1 signaling pathway. Our research findings indicate that AST may be a promising treatment for DED, offering new insights into DED treatment.

Dry eye disease (DED) is a clinically significant multifactorial disorder of the ocular surface and tear film as it results in ocular discomfort and visual impairment and predisposes the cornea to infections. It is important for the quality of life and tends to be a chronic disease. It is also common, as the prevalence is estimated between 5 % to 30 % and this increases with age. Therefore, it is recognised as a growing public health problem that requires correct diagnosis and appropriate treatment. There are two main categories of DED: the deficiency of tear production (hyposecretive), which includes Sjögren syndrome, idiopathic or secondary to connective tissue diseases (e.g. rheumatoid arthritis), and non-Sjögren syndrome (e.g. age-related); and the tear evaporation category, where tears evaporate from the ocular surface too rapidly due to intrinsic causes (e.g. meibomian gland disease or eyelid aperture disorders) or extrinsic causes (e.g. vitamin A deficiency, contact lenses wear, ocular allergies). Management of the disease aims to enhance the corneal healing and reduce patient’s discomfort. This is based on improving the balance of tear production and evaporation by increasing the tear film volume (lubrication drops) and improving quality of tear film (ex omega-3 supplements, lid hygiene, tetracyclines), reducing the tear film evaporation (paraffin ointments, therapeutic contact lenses), reducing tear’s drainage (punctal plugs, cautery) and finally by settling down the ocular surface inflammation (steroids, cyclosporine, autologous serous), as appropriate. In this article we will review the clinical presentation, differential diagnosis and treatment options for DED.

The aim of this review is to summarize the results of a consensus meeting held by a group of experts in dry eye disease (DED) to discuss the importance of tear substitutes in the treatment of DED. The meeting focused especially on the main characteristics of lacrimal substitutes, the development of in vitro models to investigate DED pathophysiology and treatment, the importance of conducting rigorous clinical trials, the requirements of the upcoming European Legislation on medical devices, the advances in the formulation of safer preservatives, the peculiarities of treatment in younger subjects, and the importance of an updated terminology for lacrimal substitutes. A literature search was conducted using MEDLINE, with different combinations of pertinent keywords, depending on the subject under discussion, such as "dry eye disease"; "tear substitutes"; "in vitro models"; "ocular surface"; "clinical trials"; "European Regulation"; "preservatives" "younger patients". Also, each author included in the discussion selected articles from their personal library. Using a consensus-based method called nominal group technique to reach a conclusion and proposal for a new classification of eye drops used to improve the tear film and ocular surface epithelia, the experts also conducted a round table meeting. The new terms proposed by the authors are "wetting agents", "multiple-action tear substitutes" or "ocular surface modulators". The new classification is needed to distinguish eye drops used to improve the tear film and ocular surface epithelia, in line with the new definition of DED, which recognizes the loss of ocular homeostasis, and the creation of a vicious circle of chronic inflammation and ocular damage as fundamental aspects of DED pathophysiology. Although tear substitutes have been historically used to provide eye lubrication to the ocular surface, recent advances in the pathophysiology of dry eye disease (DED) clarified that treatment should not just focus on tear film quality or quantity, but address the loss of homeostasis of the ocular surface, blocking the vicious circle of chronic inflammation and ocular damage. Given the scant comparative evidence on tear substitutes currently on the market, further studies should focus on developing new agents, considering the advantages provided by in vitro models, importance of conducting rigorous clinical trials, availability of less harmful preservatives and obligations related to the new European legislation on medical devices. Based on the discussion of these topics, a group of experts held a consensus meeting to identify new and more appropriate terms for different tear substitutes. The proposed terms are wetting agents, multiple-action tear substitutes and ocular surface modulators. Regardless of the agent used, it is important to note that tear substitutes represent one of many options for DED treatment, which should not overlook the psychological aspects of the disease and the peculiarities of younger subjects, who seem to have a higher risk for DED, possibly related to digital devices excessive use.

Purpose To evaluate visual display terminal (VDT)-related digital eye strain (ES) and dry eye disease (DED) symptoms in subjects whose work was changed to teleworking (TW) during the coronavirus pandemic. Methods: A digital self-reported survey was conducted on subjects in TW, including demographics, medical history, VDT time and ES-related symptoms before and during the pandemic and DED (DEQ-5 questionnaire). Results: A total of 1797 questionnaires were analyzed. The mean age was 40.5 (SD 11.1) years, and 69.9% were female. The mean number of TW weeks was 10.2 (SD 3.0). The total VDT time increased from 7.4 (SD 3.3) to 9.5 (SD 3.3) hours (p< 0.001). All ES symptoms presented a significant increase (p< 0.001). The mean DEQ-5 score was 8.3 (SD 4.9). The elderly group presented lower values, and women had a higher score (p< 0.001). Additionally, 28.6% of the subjects were classified a severe DED, and the variables associated with a logistic regression model were the total VDT hours, female sex, refractive surgery, rosacea, depression, previous DED, keratoconus, and blepharitis. Conclusions: The number of VDT hours seemed to be a relevant factor for increase in eye strain (ES) symptoms and a high prevalence of DED during the pandemic period.

Objective: This study aimed to evaluate the prevalence of dry eye disease (DED) and identify its contributing factors, with a particular focus on sun exposure and protective behaviors such as sunglasses use. Methods: This cross-sectional study included 626 participants from the Jazan region, Saudi Arabia, recruited via convenience sampling. Data were collected using an online questionnaire comprising four sections: socio demographic, medical and ophthalmic history, DED characteristics, and sun exposure and protection behaviors using the sun exposure and protection index (SEPI). A multivariable logistic regression model was used to identify independent predictors of self-reported DED. Results: Among participants, 31.6% had DED. Significant independent risk factors included a history of blepharitis (OR = 33.72, p-value = 0.003), refractive surgery (OR = 7.49, p &amp;lt; 0.001), and weekly contact lens use (OR = 5.40, p-value = 0.009). Systemic conditions, such as hyperlipidemia (OR = 2.26, p-value = 0.049) and asthma (OR = 2.07, p-value = 0.048), were also significant risk factors, as were higher sun exposure scores on the SEPI scale (OR = 1.09, p-value = 0.001) and increasing age. Conclusion: DED was highly prevalent in the Jazan region. The findings confirmed established risk factors and uniquely highlighted the modifiable risk of excessive sun exposure, as well as the protective role of sun protection behaviors, including sunglasses use, in an extreme climate.