Background: Dry eye disease (DED) is a multifactorial chronic ophthalmic disease. Its symptoms include blurry vision, foreign body sensation, pain, grittiness, ocular dryness and discomfort. Multiple studies have revealed that DED has a negative impact on patients’ quality of life, as well as their physical and mental health. In line with such findings, other research projects have indicated that depression, anxiety and stress share common risk factors associated with DED. Objective: We aimed to investigate the association between DED and depression, anxiety and stress among Saudi Arabian adults. Methods: This is a cross-sectional study conducted on 335 Saudi Arabian patients aimed to assess the prevalence of DED among individuals with depression, anxiety and stress. Data were collected using a self-administered questionnaire with the Depression Anxiety Stress Scales-21 (DASS-21) to assess the severity of stress, depression and anxiety, and the Ocular Surface Disease Index (OSDI) to assess DED symptoms. Results: The final number of participants was 448. Furthermore, 72.3% of them were aged 18 - 30 years, and 69.6% of them were females. The prevalence of depression, anxiety, and stress among patients with DED was 62.1%, 66.1%, 54%, and 77.9% respectively. Furthermore, we found that there were no significant differences between participants regarding the severity of DED based on different age groups (P = 0.889). Females with depression, anxiety, and stress, on the other hand, were significantly more likely to have severe DED than males with similar conditions. Conclusions: We confirmed a high prevalence of depression, anxiety, stress and DED in Saudi Arabian patients. There was a significant correlation between the four studied variables in which the greatest correlation was between anxiety and DED.
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