Abstract
We aim to evaluate the risk of dry eye disease (DED) occurrence in patients with surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. After exclusion, patients with a diagnostic code of CRS and had received functional endoscopic sinus surgery (FESS) were regarded as having surgery-indicated CRS and enrolled in the study group, then each patient in the study group was age- and gender-matched to four non-CRS patients that served as the control group. The outcome was considered as the development of DED and Cox proportional hazard regression was used for the statistical analysis, which involved multiple potential risk factors of DED. A total of 6076 patients with surgery-indicated CRS that received FESS and another 24,304 non-CRS individuals were enrolled after exclusion. There were 317 and 770 DED events in the study group and the control group during the 16-year follow-up interval, and the study group demonstrated a significantly higher adjusted hazard ratio (1490, 95% confidence intervals (CI): 1.303-1.702) of DED development compared to the control group in the multivariable analysis. In addition, the cumulative probability analysis illustrated a positive correlation of DED occurrence and the disease period of surgery-indicated CRS (p < 0.0001). In the subgroup analysis, both genders revealed a higher but not significant incidence of developing DED in the study group. In conclusion, the existence of surgery-indicated CRS will increase the risk of developing DED, which correlated to the disease interval.
Highlights
Chronic rhinosinusitis (CRS) refers to inflammation in the paranasal sinuses that persists for at least three months [1], and affects approximately 6% of the population [2]
Except for the symptoms mentioned above, CRS may be associated with other inflammatory disorders like allergic rhinitis and asthma [4]
To standardize the health condition of participants, we considered the effects of demographic conditions including, age, gender, and income level and the following co-morbidities in the analysis: hypertension, diabetes mellitus, ischemic heart diseases, hyperlipidemia, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease and asthma, rheumatic disease, peptic ulcer disease, liver disease, and hemiplegia/paraplegia
Summary
Chronic rhinosinusitis (CRS) refers to inflammation in the paranasal sinuses that persists for at least three months [1], and affects approximately 6% of the population [2]. In the severe form, the infection and inflammation of the paranasal sinus in CRS may even lead to the occurrence of fatal intracranial infection including brain abscesses [5]. Both medical and surgical approaches have been utilized to treat CRS [6]. Patients with certain risk factors, like higher Lund-Mackay CT scores and those with fungal-induced CRS, may still experience a poor quality of life or persistent nasal polyp formation even after successful FESS intervention [7,8]
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