Epidemiology of Dry Eye Autoimmune Disease Save

Key Takeaways

• Dry eye is often seen in conjunction with autoimmune diseases, not limited to Sjögren's disease, but the magnitude of these associations has not been characterized in detail.
• This population-based study in Taiwan examined rates of dry eye in various autoimmune diseases.
• Dry eye occurred at rates of 20%-40% in autoimmune conditions other than Sjögren's, and it was seen more often in patients not diagnosed with autoimmune disease until later in life.
• Everyone knows that dry eye is a hallmark symptom of Sjögren's disease, but the condition is often seen in patients with other autoimmune conditions. Now, a population-based study from Taiwan has quantified just how often it occurs and when.

Rates upwards of 20% were seen across nine common autoimmune diseases other than Sjögren's, most often in rheumatoid arthritis (39.3%) with Crohn's disease bringing up the rear (23.0%), according to Chi-Chin Sun, MD, PhD, of Chang Gung Memorial Hospital in Keelung, Taiwan, and colleagues.

Unsurprisingly, dry eye occurred in more than 80% of patients with Sjögren's disease, the group reported in a JAMA Network Open research letter.

One novel finding, though, was that age at autoimmune disease diagnosis often differed substantially in patients with versus without dry eye disease (DED). Those with dry eye tended to be older -- sometimes much older -- when their autoimmune disease developed enough to warrant medical attention.

As well, late-stage features of DED such as corneal ulceration also differed in prevalence among the different autoimmune conditions.

"[T]hese findings highlight the importance of early recognition and proactive management of DED to reduce ocular morbidity in autoimmune populations," Sun and colleagues wrote.

Inflammation is the common denominator of autoimmune disease, and some ophthalmologic complications may be expected. However, DED's epidemiology in conjunction with rheumatologic conditions has not been well established; few studies have tried to quantify incidence and prevalence rates in diseases other than Sjögren's, in which dry eye competes with dry mouth as the most common and most disruptive symptom.

For their study, Sun and colleagues drew on Taiwan's National Health Insurance Research Database, which maintains records for 99% of the country's population. They looked for patients with any of 10 autoimmune conditions, identifying those also diagnosed with DED as well as the timing of initial diagnosis for each.

Rates of DED in these conditions were as follows:

• Sjögren's disease: 81.3%
• Rheumatoid arthritis: 39.3%
• Systemic lupus erythematosus: 38.1%
• Polymyositis: 36.2%
• Systemic sclerosis: 34.6%
• Pemphigus: 31.3%
• Dermatopolymyositis: 31.1%
• Ulcerative colitis: 29.7%
• Vasculitis: 27.6%
• Crohn's disease: 23.0%

Across the board, female patients had higher DED rates than did males, typically by 10-15 percentage points. Another interesting observation was that DED diagnosis usually preceded overt autoimmune disease onset, by averages of about 3 years.

Also, in every category, patients with DED were at least several years older on average when they were diagnosed with autoimmune disease. This was most apparent in Crohn's disease, in which the mean age at diagnosis was 40 for those without dry eye versus 54 for those who had DED. The age gap was also seen, albeit to a lesser degree, in Sjögren's disease (54 vs 58).

The study also identified differences in how often DED progressed to more serious ophthalmic conditions such as keratitis and corneal ulcers. Patients with lupus, rheumatoid arthritis, and especially vasculitis were most likely to develop corneal ulcers following a DED diagnosis; this was seen in 11% of DED cases involving patients with vasculitis. Sun and colleagues offered that these complications indicated "more severe ocular inflammation, likely driven by shared genetic and immune pathways."

Limitations to the study included its reliance on administrative data and its restriction to the Taiwanese population. As well, Sun and colleagues noted that the records did not have detailed results from eye exams, and such factors as symptom severity and treatments patients received were not accounted for.

Source Reference: Chen N-N, et al "Epidemiology of dry eye in patients with autoimmune disease" JAMA Netw Open 2026; DOI: 10.1001/jamanetworkopen.2025.60275.