A new cohort study published in JAMA Network Open examined how frequently dry eye disease (DED) occurs across multiple autoimmune disorders and whether it appears before systemic disease is diagnosed.
The findings suggest that persistent dry eye symptoms may represent an early clinical sign of autoimmune disease in some patients.
Let’s start with the basics: Why might dry eye be connected to systemic autoimmune disease?
DED is not always limited to the ocular surface—in many cases, it reflects broader immune or inflammatory processes occurring throughout the body.
Autoimmune disorders in particular can disrupt tear production and damage ocular surface tissues when the immune system mistakenly targets structures such as the lacrimal glands or corneal epithelium.
Because of this connection: Dry eye is considered the most common ocular manifestation of autoimmune disease, occurring in roughly 10% to 95% of affected patients (depending on the condition).
- As such: Autoimmune-related dry eye often involves both aqueous tear deficiency and evaporative instability and may produce more severe ocular surface inflammation than non-autoimmune forms of the disease.
So where does this new research come in?
To better understand how dry eye appears across different autoimmune conditions, researchers analyzed population-level health data to examine three key factors:
- How common dry eye is across major autoimmune diseases
- Whether dry eye tends to appear before or after autoimmune diagnosis
- Whether ocular surface complications occur more frequently in certain diseases
The goal was to determine whether dry eye symptoms might represent an early clinical indicator of systemic autoimmune disease.
Who was included in the study?
The researchers analyzed records from the Taiwan National Health Insurance Research Database, which covers more than 99% of the country’s population.
The study included:
- 67,264 patients newly diagnosed with autoimmune diseases between 2011 and 2020
- Individuals diagnosed with 10 different autoimmune disorders, including rheumatoid arthritis, systemic lupus erythematosus and Sjögren syndrome
Rheumatoid arthritis (RA) accounted for the largest share of cases (36.6%), followed by Sjögren syndrome (34.3%).
What did the researchers find?
Dry eye disease was common across all autoimmune conditions examined, although prevalence varied considerably by disease type.
Key findings included:
- Sjögren syndrome showed the highest prevalence, with dry eye occurring in about 81% of patients
- RA had the second-highest prevalence at roughly 39%
- Crohn’s disease disease had the lowest prevalence at approximately 23%
Across all conditions studied, dry eye was also more common in women than in men.
Did dry eye appear before autoimmune disease diagnosis?
One of the most notable findings was the timing of dry eye relative to systemic disease diagnosis.
On average, dry eye symptoms appeared about 3 years before autoimmune disease was formally diagnosed.
- What this temporal pattern suggests: That ocular surface symptoms may represent an early manifestation of systemic immune dysfunction.
What complications were associated with autoimmune-related dry eye?
Keratitis and corneal ulcers occurred most frequently in several inflammatory autoimmune diseases, including:
- Sjögren syndrome
- RA
- Systemic lupus erythematosus
Investigators reasoned that these complications likely reflected the more intense inflammatory processes associated with autoimmune-related dry eye.
Any limitations to consider when interpreting the findings?
The researchers noted several …
First: The study relied on insurance claims data and diagnostic codes, which did not capture detailed clinical information such as tear film testing results or symptom severity.
Additionally, the database did not include:
- Detailed ophthalmic examination findings
- Biomarker data
- Treatment information
These limitations made it difficult to assess how disease activity or therapy may influence dry eye severity.
Why might this matter for clinical practice?
Recognizing dry eye as a possible early systemic sign could help clinicians identify autoimmune disease sooner.
For eyecare providers, persistent or severe dry eye symptoms may warrant closer evaluation for systemic conditions, particularly when other risk factors or symptoms are present.
Earlier recognition may allow patients to receive appropriate medical evaluation and treatment before more serious complications develop.
Take home.
This large population-based study suggested that DED may precede autoimmune disease diagnosis by several years in some patients.
Because ocular surface symptoms can appear before systemic disease becomes apparent, early recognition of persistent dry eye may provide an opportunity for earlier evaluation and management of underlying autoimmune conditions.