Comparison of Tear Function in Patients With and Without Mental Disorders: A Systematic Review and Meta-analysis

Eye care is crucial for patients with mental disorders, yet it is often overlooked. Previous studies suggest a link between mental disorders and dry eye disease, but results on objective tear function are inconsistent. This meta-analysis aimed to compare tear function between patients with and without mental disorders. We systematically searched Embase, PubMed, Cochrane and PsycINFO up to November 19, 2025. We included studies reporting the comparison of tear function outcomes measured by the Schirmer test or tear break-up time (TBUT) between adult patients with and without mental disorders. The meta-analysis based on a random-effects model presented pooled mean differences between groups. We included 15 studies with a total of 3,319 participants. Our meta-analysis revealed that patients with mental disorders had lower TBUT (MD: -3.72, 95% CI: -5.76 to -1.69, I 2 : 99%) and Schirmer test (MD: -4.62, 95% CI: -7.42 to -1.83, I 2 : 98%). Results remained consistent across subgroup analyses based on gender, study country, psychiatric diagnosis, psychiatric medication use and study design. Notably, significantly lower Schirmer test results were observed even in patients not receiving psychiatric medication. Compared to patients without mental disorders, patients with mental disorders were associated with poor tear function. Regular monitoring and early detection of tear dysfunction should be considered for patients with mental disorders. However, due to the substantial heterogeneity and the cross-sectional design of most included studies, the findings should be interpreted with caution and are best viewed as hypothesis-generating. • Patients with mental disorders may be prone to developing dry eye disease; however, the findings from previous studies reporting the association between psychiatric disorders and dry eye diseases remain inconsistent. • The findings from this meta-analysis of 15 studies suggested that patients with mental disorders had worse tear function, measured by tear break-up time (tear film stability) and Schirmer test (tear production), compared to the participants without mental disorders. • Due to the consistent results across different mental disorders, regular monitoring and tailored treatment of tear dysfunction should be considered for patients with mental disorders in clinical practice. • The lack of significant differences in tear functions between the elderly with and without mental disorders suggests that early detection and intervention for dry eye diseases in the elderly, regardless of mental disorder comorbidities, is necessary to ensure eye health.