Etiology
4
Table 2. Risk Factors for Dry Eye
Level of Evidence
Mostly Consistent
a
Suggestive
b
Unclear
c
Older age Asian ethnicity Cigarette smoking
Female gender Medications
• Tricyclic
antidepressants
• Selective serotonin
reuptake inhibitors
• Diuretics
• Beta-blockers
Hispanic ethnicity
Postmenopausal estrogen
therapy
Medications
• Anticholinergics
• Anxiolytics
• Antipsychotics
Low dietary intake of
omega-3 fatty acids
Medications
• Antihistamines
Connective-tissue disease Diabetes mellitus Alcohol use
LASIK and refractive
excimer laser surgery
HIV/HTLV1 infection Menopause
Radiation therapy Systemic chemotherapy Botulinum toxin injection
Hematopoietic stem cell
transplantation
Large-incision ECCE and
penetrating keratoplasty
Acne
Vitamin A deficiency Isotretinoin Gout
Hepatitis C infection Low-humidity environments Oral contraceptives
Androgen deficiency Sarcoidosis Pregnancy
Ovarian dysfunction
a
Mostly consistent evidence implies the existence of at least one adequately powered and
otherwise well-conducted study published in a peer-reviewed journal, along with the
existence of a plausible biological rationale and corroborating basic research or clinical data.
b
Suggestive evidence implies the existence of either 1) inconclusive information from peer-
reviewed publication or 2) inconclusive or limited information to support the association, but
either not published or published somewhere other than in a peer-reviewed journal.
c
Unclear evidence implies either directly conflicting information in peer-reviewed publications
or inconclusive information but with some basis for a biological rationale.
Reproduced with permission from Smith JA (Chair). Epidemiolog y Subcommittee of
the International Dry Eye Workshop. e epidemiolog y of dry eye disease: report of the
Epidemiolog y Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf.
2007;5:99.
ECCE, extracapsular cataract extraction; HIV, human immunodeficiency virus; HTLV,
human T-cell lymphotropic virus; LASIK, laser-assisted in situ keratomileusis
