Tathagata Roy, B. Optom

Intern Optom, Dr. Shroff’s Charity Eye Hospital, New Delhi, India.


Violation of tear secretion and tear film stability leads to Dry Eye Disease (DED), in which the quality of sleep plays an important role. (1) Tear deficiency, excessive tear evaporation, ocular surface inflammation and corneo-conjunctival epitheliopathy are included under the criteria of visual and non-visual symptoms which are the characteristics of DED.(2) DED is most prevalent in women of climacteric age, and they suffer from low quality of life, which may be associated with the severity of DED.


In a recent murine model,(3) sleep deprivation was demonstrated to induce dry eyes through abnormal superficial corneal epithelial cell microvilli morphology. Recent studies have reported that depression is a common condition among the subjects with DED. (3) Another important observation was that depression is included as a common psychiatric problem in women that is closely associated with sleep disorders. There are marked effects of hormonal changes on women’s health, including mental health, the endocrine system, obstructive sleep apnoea, and the circulatory system that  have been noticed during the perimenopausal period. As a newer treatment for Menopause-related disorders and DED Hormone-replacement therapy has been introduced.(1) Even though we know some interlinked physical status like sleep quality, mood statuses might affect one another as well as DED. But till now no study has evaluated sleep and mood disorders in women with DED over a broad age range.

DED develops predominantly in menopausal women, and they are at risk for a variety of health problems, including sleep, mood disorders, and sleep apnoea syndrome. Hormone replacement therapy (HRT) with oestrogen is known to be effective for menopausal symptoms, including sleep. It is reported that HRT may be effective for DED (!) however, this finding is controversial since other strictly controlled studies have suggested that women who use HRT, particularly oestrogen alone, are at increased risk of DED. Ophthalmologists caring for women who are taking or considering HRT should consider this potential adverse effect.

DED secondary to sleep disorder:

Work by Schaumberg et.al., reported that cataract patients presented with yellow nuclear opacities had sleep disorders and DED that improved after cataract extraction surgery.(2)

In the case of circadian rhythm sleep-wake disorders (3) (CRSWD) also known as family sleep-disorders, cognitive disorders and melancholy in older adults where Light therapy is accredited as an effective intervention.

Glaucoma has a fundamental aetiology of programmed cell death of retinal ganglion cells (RGCs), and its subgroup ipRGC expresses  a newly identified opsin (melanopsin) that modulates photo synchronisation of the superior chiasmatic nucleus, the master clock in the body.

In relation to increased inflammation by tear hyperosmolarity, androgen levels, the parasympathetic nervous system, and blinking there is a significant association of sleep deprivation with DED.(2) Millions of people worldwide are affected through DED, with prevalence estimates ranges from 5% to 50% across populations.(3) A seemingly common condition which has significant effect on the quality of life is possible to manage to a great extent by addressing the associated disease conditions and promoting awareness



  1. Lee, Y. B. et al. Sleep deprivation reduces tear secretion and impairs the tear film. Invest. Ophthalmol. Vis. Sci. 55, 3525–3531 (2014).
  2. Schaumberg, D. A., Dana, R., Buring, J. E. & Sullivan, D. A. Prevalence of dry eye disease among US men: estimates from the Physicians’ Health Studies. Arch. Ophthalmol. 127, 763–768 (2009).
  3. Tang L, Wang X, Wu J, Li SM, Zhang Z, Wu S, Su T, Lin Z, Chen X, Liao X, Bai T, Qui Y, Reinach PS, Li W, Chen Y, Liu Z. Sleep deprivation induces dry eye through inhibition of PPARα expression in corneal epithelium.Invest Ophthalmol Vis Sci. 2018 Nov 1;59(13):5494