This retrospective cohort study evaluated whether chronic pain conditions (CPCs) are associated with increased risk of incident dry eye disease (DED) and prescription-requiring DED in adults (≥18 years) using the TriNetX Analytics Network (2005–2025), with 538,364 propensity score-matched patients per cohort followed for up to 3 years.
At 3 years, incident DED occurred in 7.16% of CPC patients vs. 1.50% of controls (RR 4.78; 95% CI 4.66–4.89; p<0.0001); prescription-requiring DED occurred in 0.79% vs. 0.30% (RR 2.60; 95% CI 2.45–2.75). Multivariable Cox regression confirmed an independent association (HR 4.85; 95% CI 4.76–4.94; p<0.0001).
- Retrospective EHR design limits causal inference and may introduce coding/ascertainment bias. - Controls were required to have *no* CPC diagnoses before or after the index visit, which may create an unusually healthy comparator group and inflate effect sizes. - DED defined by diagnosis codes only; severity and objective signs could not be verified.
Screen patients with chronic pain conditions proactively for dry eye disease, as their risk is nearly 5-fold higher than pain-free controls. Consider CPCs a meaningful risk factor when evaluating DED, and recognize that some DED presentations may reflect central pain-processing dysfunction rather than isolated ocular surface disease.
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