Systemic Associations With Signs, Symptoms, and Their Discordance in an Indian Population With Dry Eye Disease

Objective: To identify systemic conditions associated with dry eye disease (DED) symptoms, signs, and their discordance in a clinically diagnosed DED cohort. Methods: In this prospective cross-sectional study, participants with DED were assessed for systemic conditions through self-reported history, health records, and specialist referrals. Dry eye disease symptom and sign scores were transformed to a 0 to 1 scale using linear transformation. A discord score (symptom score–sign score) was calculated. Associations between systemic conditions and DED parameters were analyzed using linear regression. Results: The study included 371 DED participants (mean age: 52.9±14.0 years; 226 women). No significant correlation was observed between signs and symptoms (Spearman rho = −0.08; P =0.08). Increasing age (β = −0.005; P <0.001) and longer DED duration (β = −0.003; P <0.001) were associated with higher signs than symptoms. Atopy, chronic gastrointestinal disorders, psychological disorders, and hormonal replacement therapy use were associated with more severe DED symptoms than signs (all P ≤0.03). Female sex, graft-versus-host disease, Sjögren disease, and rheumatoid arthritis were associated with more severe DED signs and a symptom–sign discordance (all P ≤0.04). Conclusion: Systemic conditions significantly affect how DED presents and may cause symptom–sign mismatch, highlighting the need for thorough systemic history and evaluation in DED.