Vitamin D Deficiency Strongly Associated With Dry Eye in Premenopausal Women

by | Sep 7, 2016 | 2016, Eye Health, Vitamin D - Recommended Levels, Women's Health

Written by James C. Morton Jr., Staff Writer. Premenopausal women with vitamin D deficiency revealed dry eye association p<0.001 compared to controlled group.

eye healthDry eye is a common and often a chronic condition, particularly in older adults. It is characterized by a person not producing enough tears to lubricate and nourish the eye, or producing poor quality tears (oil, water, mucus) that aids in clear vision, protects the surface (cornea), and prevents evaporation of water (1).This leads to symptoms of ocular discomfort, soreness, redness, sensitivity to light, and blurred vision due to inflammatory mediators. The current statistics on the direct health care cost in the United States for dry eye is $3.8 billion annually (2).

The most popular approaches for dry eye are: adding tears by artificial tear solutions, conserving tears by blocking tear ducts with silicone, gel-like plugs, or through surgical closure of ducts; or increasing tears by prescribed eye drops that treat eyelid or ocular inflammation (1). Vitamin D, an essential fat-soluble vitamin, functions in cartilage, bone, and plays a role in musculoskeletal and mental health (3). Vitamin D deficiency is linked to malignancies, metabolic syndrome, hypertension and cardiovascular disease and myopia health problems (4, 5, 6).

A 2016 study (7) suggests that vitamin D deficiency is strongly associated with dry eye. This study involved 50 premenopausal women with vitamin D deficiency (< 20ng/mL) aged (23 to 50). They were compared to a control group of 48 women with normal vitamin D levels (> 20ng/mL) aged (22 to 50) and assessed dry eye association using Schirmer’s Test (wetness), Tear Break-up Time Test (interval between blink and first dry point on cornea) , and Ocular Surface Disease Index ( evaluating symptoms of ocular irritation and dry eye impact) (8, 9). After the study, additional statistical analysis (Stanford Health Assessment Questionnaire – HAQ, Fatigue severity scale- FSS, and Visual analogue scale-pain) were used to assess clinical parameters using Mann-Whitney U-test, independent t-test, and Pearson’s correlation coefficient.

After completion of the study, those with vitamin D deficiency had a mean level of vitamin D (1.4 to 19.9) compared to the control group (20.4 to 110.5, p < 0.001). Schirmer’s test and Tear Break-up Time Test were lower by (52% – 12.71 versus 24.7, and 62% – 7.85 versus 13.27, p < 0.001) respectively for those who were vitamin D deficient compared to the control group. For the vitamin D deficient group, scores were higher in Ocular Surface Disease Index (53% – 35.78 versus 18.69), Visual analogue scale-pain (50% – 5.52 versus 2.73), HAQ (45% – 11.28 versus 5), and FSS (51% – 44.6 versus 23.2) (all p < 0.001). Age did not differ significantly between groups p = 0.08.

When suggesting how vitamin D deficiency has a strong association with dry eye, the researchers pointed to vitamin D’s strong critical role that induces cathelicidin, an antimicrobial peptide produced by epithelial cells in the corneal and conjunctiva of the eye (10, 11). Vitamin D plays a role in wound healing, enhancing tear film parameters, and reduces ocular surface inflammation (12, 13). They conclude that vitamin D deficiency’s strong association with dry eye is related in terms of quantity of tears, stability of tear film layer, symptoms of ocular irritation. Patients should be evaluated for dry eye with vitamin D deficiency, since vitamin D plays a protective role.

Source: Yildirim, Pelin, Yeşim Garip, Ayse Aslihan Karci, and Tuba Guler. “Dry eye in vitamin D deficiency: more than an incidental association.” International journal of rheumatic diseases 19, no. 1 (2016): 49-54.

© 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd

Posted September 6, 2016.

References:

  1. “Dry Eye” posted on the American Optometric Association’s website.
  2. “Dry Eye Treatment” posted on TearScience’s website.
  3. “Vitamin-D Deficiency” posted on Center for Disease Control and Prevention website.
  4. Yazar S, Hewitt AW, Black LJ et al. (2014) Myopia is associated with lower vitamin D status in young adult. Invest Ophthalmos Vis Sci 55, 4552-9.
  5. Pereira F, Larriba MJ, Munoz A (2012) Vitamin D and colon cancer. Endocr Relat Cancer 19, 51-71.
  6. Etemadifar M, Abtahi SH, Razmjoo H, Abtahi MA, Dehghani A, Salari M (2012) 25-hydroxyvitamin D concentrations in patients with optic neuritis as a clinically isolated syndrome and healthy controls. Int J Prev Med 3,313-7.
  7. Pelin Y, Yesim, G, Ayse AK, and Tuba G. (2016). Dry eye in vitamin D deficiency: more than an incidential association. International Journal of Rheumatic Diseases. 19: 49-54.
  8. Norn Ms (1969) Desiccation of the precorneal film. I Corneal wetting time. Acta Ophthalmol 47, 865-80.
  9. Schiffman RM, Christianson MD, Jocobsen G, Hirsch JD, Reis BL (2000) Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 118, 615-21.
  10. Guo C, Combart AF (2014) The antibiotic effects of vitamin D. Endocr Metab Immune Disord Drug Targets 14, 255-66.
  11. Hata TR, Kotol P, Jackson M et al. (2008) Administration of oral vitamin D induces cathelicidin production in atopic individuals. J Allergy Clin Immunol 122, 829-31.
  12. Wei Y, Asbell Pa (2014) The core mechanism of dry eye disease is inflammation. Eye Contact Lens 40, 248-56.
  13. Massingale ML, Li X, Vallabhajosyula M, Chen D, Wei Y, Asbell PA (2009) Analysis of inflammatory cytokines in the tears of dry eye patients. Cornea 28, 1023-7.