Sedentary Behavior Could Increase Risk of Dry Eye Disease

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In a Dutch population, greater sedentary behavior was associated with an increased risk of DED, but data suggest the association was only significant for those with less than recommended physical activity.

A new cross-sectional study from the Netherlands suggests increased sedentary time may subsequently increase dry eye disease (DED) risk, even after adjusting for medical comorbidities.1

When excluding computer use-intensive sitting time from total sitting time, the association remained significant between sedentary behavior and highly symptomatic dry eye, but not for clinical diagnosis of DED. However, sufficient physical activity attenuated the increased risk of dry eye from sedentary behavior, according to the data.

“Screen use, medical comorbidities, and sufficient physical activity should, therefore, be considered as key confounding factors in the relationship between sedentary behavior and dry eye disease,” investigators wrote.1

The link between sedentary behavior and DED remains unclear, with both positive and negative associations reported in previous studies.2 In the current study, investigators led by Jelle Vehof, MD, PhD, Dutch Dry Eye Clinic, were the first to assess this relationship in a European population as well as the first to test if physical activity was an effect modifier of the association.

Using the population-based Lifelines cohort, a baseline assessment (1A) was conducted between 2007 and 2012, followed by two questionnaires. A second assessment (2A) was performed between 2014 and 2017, with a follow-up questionnaire provided between 2015 and 2019.

Status of DED was assessed at 2A with the Women’s Health Study (WHS) dry eye questionnaire, with the main outcome measure of the study being WHS-defined DED. Participants indicated their sedentary behavior in total daily sitting time using the Marshall Sitting Questionnaire (MSQ) and their physical activity with the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH).

Results show the prevalence of WHS-defined DED was 9.1% in the total population of 48,418 participants, with females being more than twice as likely to have DED than males (12.1% vs. 5.0%). Greater sedentary behavior was linked to a higher risk of WHS-defined DED in all analyses.

Each hour of daily sedentary behavior time increased the odds of having WHS-defined DED by 1.5% (odds ratio [OR], 1.015 per hour/day; 95% confidence interval [CI], 1.005 – 1.024; P = .004). Meanwhile, the data suggest sedentary behavior was linked to a higher risk increase for highly symptomatic dry eye (OR, 1.045) than for clinical diagnosis (OR, 1.010).

After excluding sitting time from computer use-intensive domains, investigators found the association between sedentary behavior and WHS-defined DED was no longer significant (OR 1.007 per hour of sitting/day; 95% CI, 0.993 - 1.022; P = .31). Sedentary behavior without computer use was significantly linked to highly symptomatic dry eye in all models, but not with a clinical diagnosis after adjustments for 48 medical comorbidities.

Regarding physical activity, the association between sedentary behavior and DED was only significant for those with less than WHO recommendations (OR, 1.022; 95% CI, 1.002 - 1.042; P = .027) and not in those meeting WHO recommendations (OR, 1.011; 95% CI, 0.999 - 1.023; P = .076).

Based on this analysis, physical activity may protect against DED, but investigators could not confirm the link, noting “causation cannot be assumed from this cross-sectional study.”1


1. Nguyen L, Magno MS, Utheim TP, Hammond CJ, Vehof J. The relationship between sedentary behavior and dry eye disease. The Ocular Surface. 2023;28:11-17. doi:10.1016/j.jtos.2023.01.002

2. Hanyuda A, Sawada N, Uchino M, et al. Physical inactivity, prolonged sedentary behaviors, and use of visual display terminals as potential risk factors for dry eye disease: JPHC-next study. The Ocular Surface. 2020;18(1):56-63. doi:10.1016/j.jtos.2019.09.007