A new cross-sectional study from the Eye Hospital of Shandong First Medical University has highlighted that subthreshold anxiety disorder — a condition that does not meet the diagnostic criteria for full-blown anxiety — is significantly associated with both symptoms and signs of dry eye disease (DED). The findings, published in Scientific Reports, suggest that even mild anxiety can exacerbate ocular discomfort and tear dysfunction, underscoring the need for psychological screening in DED management.
The study analyzed 127 outpatients diagnosed with DED, categorizing them into three groups: subthreshold anxiety disorder, full-blown anxiety disorder, and mentally healthy controls. Each participant underwent standardized evaluations using the Ocular Surface Disease Index (OSDI), strip meniscometry (SM), non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), corneal fluorescein staining (tCFS), and meibomian gland dysfunction (MGD) scoring. Anxiety levels were assessed using the Hospital Anxiety and Depression Scale (HADS-A) and the Mini-International Neuropsychiatric Interview (M.I.N.I.).
Patients with subthreshold anxiety demonstrated significantly worse DED symptoms and tear film parameters compared to the mentally healthy group, though less severe than those with full-blown anxiety.
OSDI scores were higher in subthreshold anxiety patients than in healthy controls, but lower than in full-blown anxiety.
Tear meniscus height (TMH) and strip meniscometry (SM) values were reduced in both anxiety groups, indicating compromised tear production.
The HADS-A score correlated strongly with OSDI, suggesting a clear psychophysical relationship between anxiety severity and perceived ocular discomfort.
Interestingly, while symptom severity increased with anxiety, correlations between anxiety and objective DED signs were weaker. The study noted a negative correlation between anxiety and tear parameters, consistent with the long-recognized symptom–sign dissociation in DED.
Notably, insomnia was more prevalent in both anxiety subgroups compared with the control group. This reinforces the interplay between sleep quality, psychological health, and ocular surface stability — a triad increasingly recognized in DED pathophysiology.
The authors emphasize that subthreshold anxiety disorder was more common than full-blown anxiety among DED patients, suggesting that many individuals with psychological distress may go unrecognized in ophthalmic settings. These findings call for integrated mental health assessment during DED evaluation, particularly when symptom intensity appears disproportionate to clinical signs.
