Research Article| Volume 43, ISSUE 4, P355-358, August 2020

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Prevalence and risk factors of symptomatic dry eye disease in Lebanon

Published:August 09, 2019DOI:


      • The Lebanese population is highly diagnosed with symptomatic DED.
      • There is a statistical association between symptomatic DED and smoking in Lebanon.
      • There is a statistical association between symptomatic DED and age in Lebanon.
      • Lebanese smokers have higher prevalence of dry eye symptoms than the non-smokers.



      To estimate the prevalence of symptomatic dry eye disease (DED) and investigate its associated risk factors in the Lebanese population.


      Population-based cross-sectional study of 602 participants from Lebanon aged 18 years and older. Ocular Surface Disease Index (OSDI) questionnaire on dry eye symptoms was used to evaluate the prevalence of symptomatic DED. Chi-square test was used to investigate the association between DED status and risk factors such as age, gender and smoking tobacco.


      The percentage of DED among the study population (271 males and 331 females) was 36.4% with OSDI score ≥ 13 (mild to moderate and severe OSDI status). The most reported DED symptom in the population was sensitivity to light. Smokers reported higher DED symptoms than non-smokers. Older and smoker populations were more likely to report significantly higher OSDI scores (p < 0.05). Moreover, gender was not statistically associated with DED (p > 0.05).


      Symptomatic DED is substantial in Lebanon. It is statistically associated with the age of population and their tobacco exposure.


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        • Brewitt H.
        • Sistani F.
        • Hannover M.H.
        Dry eye disease : the scale of the problem.
        Surv Ophthalmol. 2001; 45: S199-202
        • Craig J.P.
        • Nichols K.K.
        • Akpek E.K.
        • Caffery B.
        • Dua H.S.
        • Joo C.K.
        • et al.
        TFOS DEWS II definition and classification report.
        Ocul Surf. 2017; 15: 276-283
      1. The International Dry Eye Workshop. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007).
        Ocul Surf. 2007; : 75-92
        • Stapleton F.
        • Alves M.
        • Bunya V.Y.
        • Jalbert I.
        • Lekhanont K.
        • Malet F.
        • et al.
        TFOS DEWS II epidemiology report.
        Ocul Surf. 2017; 15: 334-365
        • Bakkar M.M.
        • Shihadeh W.A.
        • Haddad M.F.
        • Khader Y.S.
        Contact Lens and Anterior Eye Epidemiology of symptoms of dry eye disease (DED) in Jordan : a cross-sectional non-clinical population-based study.
        Contact Lens Anterior Eye. 2016; 39: 197-202
        • Vehof J.
        • Kozareva D.
        • Hysi P.G.
        • Hammond C.J.
        Prevalence and risk factors of dry eye disease in a British female cohort.
        Br J Ophthalmol. 2014; 98: 1712-1717
        • Lam D.K.T.
        • Wong V.W.Y.
        • Chow V.W.S.
        • Chi stanley C.C.
        Epidemiology of dry eye syndrome in Hong Kong : a cross-sectional population-based study.
        Hong Kong J Ophthalmol. 2012; 15: 58-62
        • Onwubiko S.N.
        • Eze B.I.
        • Udeh N.N.
        • Arinze O.C.
        • Onwasigwe E.N.
        • Umeh R.E.
        Dry eye disease: prevalence, distribution and determinants in a hospital-based population.
        Contact Lens Anterior Eye. 2014; 37: 157-161
        • Farrand K.F.
        • Fridman M.
        • Stillman I.O.
        • Schaumberg D.A.
        Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older.
        Am J Ophthalmol. 2017; 182: 90-98
        • Tan L.L.
        • Morgan P.
        • Cai Z.Q.
        • Straughan R.A.
        Prevalence of and risk factors for symptomatic dry eye disease in Singapore.
        Clin Exp Optom. 2015; 98: 45-53
        • Schiffman R.M.
        • Christianson M.D.
        • Jacobsen G.
        • Hirsch J.D.
        • Reis B.L.
        Reliability and validity of the ocular surface disease index.
        Arch Ophthalmol. 2000; 118: 615-621
        • Fagehi R.
        • Ghazal H.
        • Alrabiah S.
        • Abusharha A.
        • Alanazi S.
        • Alsaqr A.
        • et al.
        Ocular dryness assessment in Saudi employees working indoors and outdoors.
        Clin Optom. 2018; 10: 51-56
        • El Hajj Moussa W.G.
        • Farhat R.G.
        • Nehme J.C.
        • Sahyoun M.A.
        • Schakal A.R.
        • et al.
        Comparison of efficacy and ocular surface disease index score between bimatoprost, latanoprost, Travoprost, and Tafluprost in Glaucoma patients.
        J Ophthalmol. 2018; 2018
        • Grubbs J.R.
        • Tollesson-Rinehar S.
        • Huynh K.
        • Davis R.M.
        A review of quality of life measures in dry eye questionnaires.
        Cornea. 2014; 33: 215-218
        • Prokopich C.L.
        • Bitton E.
        • Caffery B.
        • Michaud L.
        • Cunningham D.N.
        • Karpecki P.M.
        • et al.
        Screening, diagnosis and management of dry eye disease : practical guidelines for canadian optometrists.
        Can J Optom. 2015; 76: 4-26
        • Moss S.E.
        • Klein R.
        • Klein B.E.K.
        Prevalence of and risk factors for dry eye syndrome.
        Arch Ophthalmol. 2000; 118: 1264-1268
        • Stapleton F.
        • Stretton S.
        • Skotnitsky C.
        • Sweeney D.F.
        Silicone hydrogel contact lenses and the ocular surface.
        Ocul Surf. 2006; 4: 24-43
        • Sapkota K.
        • Martin R.
        • Franco S.
        • Lira M.
        Common symptoms of Nepalese soft contact lens wearers : a pilot study.
        J Optom. 2015; 8: 200-205
        • Mathers W.
        • Stovall D.
        • Lane J.
        • Zimmerman M.
        • Johnson S.
        Menopause and tear function: the influence of prolactin and sex hormones on human tear production.
        Cornea. 1998; 17: 353-358
        • Van Haeringen N.J.
        Aging and the lacrimal system.
        Br J Ophthalmol. 1997; 81: 824-826
        • Aktaş S.
        • Tetikoğlu M.
        • Koçak A.
        • Kocacan M.
        • Aktaş H.
        • Sağdık H.M.
        • et al.
        Impact of smoking on the ocular surface, tear function, and tear osmolarity.
        Curr Eye Res. 2017; 42: 1585-1589
        • Erginturk Acar D.
        • Acar U.
        • Tunay Z.O.
        • Ozdemir O.
        • Germen H.
        The effects of smoking on dry eye parameters in healthy women.
        Cutan Ocul Toxicol. 2016; 36: 1-4
        • El-Roueiheb Z.
        • Tamim H.
        • Kanj M.
        • Jabbour S.
        • Alayan I.
        • Musharrafieh U.
        Cigarette and waterpipe smoking among Lebanese adolescents, a cross-sectional study, 2003 – 2004.
        Nicotine Tob Res. 2008; 10: 309-314
        • Satici A.
        • Bitiren M.
        • Ozardali I.
        • Vural H.
        The effects of chronic smoking on the ocular surface and tear characteristics : a clinical, histological and biochemical study.
        Acta Ophthalmol Scand. 2003; 81: 583-587
        • Thomas J.
        • Jacob G.P.
        • Abraham L.
        • Noushad B.
        • Jacob G.P.
        The effect of smoking on the ocular surface and the precorneal tear film.
        Australas Med J. 2012; 5: 221-227
        • Eissenberg T.
        • Shihadeh A.
        Waterpipe Tobacco and Cigarette Smoking. Direct Comparison of Toxicant Exposure.
        Am J Prev Med. 2009; 37: 518-523