Gestational Age Linked With Dry Eye Disease in Pregnant Patients

Doctor talking with a young pregnant woman and her husband at the clinic waiting room
Mature female doctor talking with a pregnant young woman and her husband and explaining them a medical procedure.
The study shows evaporative dry eye is more common than aqueous deficient dry eye in pregnant patients, but that most cases could not be classified.

Gestational age is linked with dry eye disease in healthy pregnant patients, according to an investigation published in PLOS One.

Previous research that involved small sample sizes has indicated that patients experience increased dry eye disease (DED) symptoms, including decreased tears, during pregnancy. Researchers reviewed the frequency, risk factors, and subtypes of DED in these patients during pregnancy, and the effect of topical ophthalmic medications on the fetus.

Pregnant individuals (n=201 aged mean 29±4.74 years) were included in the study if they met criteria that precluded history of ocular surgeries, systemic disease, ocular surface abnormalities, or psychological conditions.

Researchers diagnosed individuals with DED if their ocular surface disease index (OSDI) was at least 13 and tear breakup time was less than 10 seconds or if ocular surface staining was at least 3. Diagnosis with aqueous deficient DED required Schirmer’s 1 test value of 5 or lower. Meibomian gland dysfunction (MGD) diagnosis entailed evaporative dry eye. Mixed dry eye diagnosis comprised MGD and abnormal Schirmer 1 test score. If Schirmer test was greater than 5 and MGD was not present, the individual was said to have unclassifiable dry eye. 

Eighty-two patients had DED (15 evaporative, 10 aqueous deficient, 6 mixed, 51 unclassified).

Increasing gestational age was linked with DED in multivariate binary logistic regression (P <.05).

The researchers found no difference in frequency of DED across trimester and no link between dry eye and age, BMI, very low density lipo-protein, low-density lipoprotein, high-density lipoprotein and triglycerides, serum prolactin level, serum testosterone level, ocular protection index, or blink rate in univariate analysis.

The study shows an association between DED and gestational age, but no link between dry eye disease and trimester, which “can be explained by the fact that 2 pregnancies could be in the same trimester but have an entirely different gestational age,” researchers explain. They said the high number of unclassified patients “implies that other etiological instigators might be responsible for dry eye clinical signs and symptoms.”

Evaporative dry eye and mixed dry eye had higher symptoms scores compared with aqueous deficient dry eye and unclassifiable dry eye.

“This implies that evaporative dry eye may be more symptomatic compared to aqueous deficient dry eye,” report researchers. “This finding is consistent with the study by Lemp et al, which found subjects with evaporative dry eye demonstrated less ocular surface staining and higher OSDI scores compared with the mixed subtype and even aqueous deficient dry eye.”

Limitations of the study included a lack of clinical history of cases of dry eye, inability to determine longitudinal association, and no tear osmolarity measurement.


Asiedu K, Kyei S, Adanusa M, et al. Dry eye, its clinical subtypes and associated factors in healthy pregnancy: a cross-sectional study. PLOS One. Published online October 7, 2021. 10.1371/journal.pone.0258233