Sex Disparity in How Pain Sensitivity Influences Dry Eye Symptoms

Abstract

Purpose: Women have a higher dry eye disease prevalence compared with men, although only relatively minor differences in the ocular surface have been observed. Interestingly, a sex difference in pain sensitivity is known, and recent research suggests that pain sensitivity is associated with dry eye symptoms. This study attempts to discern whether the association between pain sensitivity and dry eye symptoms varies between women and men. Methods: In this prospective cross-sectional study, subjects were seen for one visit where they were asked to fill out a set of questionnaires consisting of the Pain Sensitivity Questionnaire, Ocular Surface Disease Index (OSDI), and other dry eye questionnaires. This was followed by an ocular surface assessment on both eyes. Results: Two hundred eighty-seven subjects (194 women, 93 men) completed the study. Intersex differences in the ocular surface were noted. Even after accounting for these differences, an interaction effect between sex and Pain Sensitivity Questionnaire-minor score on dry eye symptoms was observed, with only women noting increased symptoms on the OSDI (P , 0.005) and other dry eye questionnaires (P values ranging from 0.01 to ,0.005) with greater pain sensitivity. After controlling for other variables, women with the highest pain sensitivity had a 17-point higher OSDI score and greater symptoms, as reported by all the other dry questionnaires compared with their male counterparts. Conclusions: The role of pain sensitivity on dry eye symptoms appears to vary between women and men. This difference provides insight into why women have a significantly higher dry eye disease prevalence than men.

Ocular surface health of the Finnish elderly population

“… 2021 ). Supporting findings arise from the recent study by Li and Lin ( 2019 ), where increased DE symptoms of women were associated with a greater pain sensitivity, whereas in men, there was no such association. In the future, studies on sex differences in self‐reported symptoms and potential differences in corneal sensitivity might help to understand better these findings.…”

Ocular surface cooling rate associated with tear film characteristics and the maximum interblink period

“…There were significantly more females than males in the group that exhibited OSC. This difference may be due to higher dry eye prevalence in females than males 29 – 36 . Sex-associated differences have been noted in the amount of meibomian lipids on the lid margins, greater in males than in females, and in lacrimal gland physiology 37 , 38 .…”

Evaluation of Ocular Surface after Cataract Surgery—A Prospective Study

“…Li and others tried to find a connection between DED symptoms and sensitivity to pain for both sexes. In women, greater pain sensitivity was found to be associated with higher OSDI and other DED questionnaire scores, whereas in men, depending on the questionnaire, greater pain sensitivity was either not associated with dry eye symptoms or associated with decreased dry eye symptoms [ 36 ]. In our study, OSDI scores increased postoperatively in women, although objective test results, such as Schirmer’s test and TBUT did not change significantly.…”