Association of rheumatoid arthritis with aqueous deficient dry eye development

Abstract Purpose: to evaluate rheumatoid arthritis (RA) as a potential risk factor for the development of aqueous deficient dry eye (ADDE) compared to evaporative dry eye (EDE). Study Design: The study design was observational and cross-sectional. Methods: Two hundred volunteer participants with dry eye disease (DED) were recruited based on the TFOS DEWS II criteria, which included tear film osmolarity, Fluorescein Break-Up Time, and ocular surface damage assessment. To obtain OSDI scores, demographics, and RA diagnosis by their medical doctor, participants were recruited using QR codes linked to designated mobile Forms. Tear meniscus height and lipid layer pattern were measured in all participants to differentiate between ADDE, EDE, or Mixed dry eye in addition to the DED diagnostic criteria. Results: after the initial recruitment, a total of 113 eligible participants were included in the final analysis. The ADDE group had a higher likelihood of having RA (OR 5.65, 95% CI 1.20-26.55) compared to the EDE group. Additionally, the number of participants with RA in the ADDE group was statistically higher than those in the EDE group (Fisher's exact test, all p = 0.020). Furthermore, a correlation was obtained between RA and an ADDE differential diagnosis (Cramer's V = 0.227, p = 0.026). Conclusion: the present study supports the hypothesis that RA could be a risk factor for the development of ADDE over EDE type.