Sex Differences and Discordance Between Symptoms and Signs of Dry Eye Disease

Abstract

PurposeTo examine the initial presenting symptoms in relation to sex and identify predictors of discordance between symptoms and signs of dry eye disease (DED) in Taiwan. DesignRetrospective cross-sectional study. MethodsSetting: Clinic-based cohort from a tertiary referral center in Taiwan. Study Population: 1229 patients diagnosed with DED at Keelung Chang Gung Memorial Hospital in Taiwan between August 1, 2011, and July 31, 2018. Main Outcome Measures: Initial presenting symptoms were cross-sectionally and retrospectively collected. The composite score, indicating the discordance between symptoms and signs, was derived from the difference between the DED symptom severity score and the DED sign severity score. ResultsOut of the total 1229 patients, 79.3% (975) were female, with a mean age of 56.7 ± 14.9 years. Initial presenting symptoms didn't show significant sex differences (all p > 0.05). In multivariate analysis, predictors of higher symptom severity score than sign severity score included being female (p = 0.011), and having past surgical history of cataract (p = 0.037), pterygium, or conjunctivochalasis (p = 0.014). Conversely, older age (p < 0.001) and artificial tear use (p < 0.001) were significant predictors of a lower symptom severity score than sign severity score. ConclusionsStrong predictors of incongruity between DED symptoms and signs include age, gender, surgical history for cataract, pterygium or conjunctivochalasis, and artificial tear use. Ophthalmologists should prioritize symptoms for female patients and post-surgery cases. Additionally, the absence of symptoms shouldn't dismiss DED possibility in older adult patients and those using artificial tears. Notably, early recognition and enhancement of postoperative care can improve patient satisfaction and quality of life.