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Cohort studyAmerican journal of ophthalmology · 2026

Risk of Incident Dry Eye Disease Among Patients with Chronic Pain Conditions.

Shannan Berzack, Shon B Shmushkevich, Charles Zhang … Anat Galor

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OphthalmologyCohort study

Chronic pain conditions are associated with a nearly five-fold higher hazard of dry eye disease.

Risk of Incident Dry Eye Disease Among Patients with Chronic Pain Conditions.

Shannan Berzack et al. · American journal of ophthalmology · 2026

Purpose

To evaluate whether chronic pain conditions (CPCs) are associated with increased risk of incident dry eye disease (DED) and prescription-requiring DED in a large electronic health record network.

Methods

After 1:1 propensity score-matching, 538,364 patients were included per cohort.

n = 538,364 patients

Results

chronic pain conditions mean a nearly five times higher risk of developing dry eye disease

RR by subgroup · 95% CI

More results

Patients with at least one CPC diagnosis had significantly higher risk of incident DED compared with controls at all follow-up intervals.

At 1 year, incident DED occurred in 3.34% of the CPC cohort versus 0.72% (RR 4.64; 95% CI, 4.49-4.81; p<0.0001).

At 3 years, cumulative incidence increased to 7.16% versus 1.50% (RR 4.78; 95% CI, 4.66-4.89; p<0.0001).

More results

Prescription-requiring DED was also more common in the CPC cohort at 3 years (0.79% vs 0.30%; RR 2.60; 95% CI, 2.45-2.75).

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Conclusion · 1 of 2

CPCs are strongly associated with an increased risk of incident and prescription-requiring DED.

Conclusion · 2 of 2

These findings support consideration of CPCs as risk factors in the evaluation and management of DED and suggest that a subset of patients with DED may reflect broader pain-processing abnormalities.

Post

Risk of Incident Dry Eye Disease Among Patients with Chronic Pain Conditions.

Chronic pain conditions are associated with a nearly five-fold higher hazard of dry eye disease.

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