Dry eye disease (DED) is a common condition with a global prevalence estimated at 11.6%1. While DED is often idiopathic, the 2017 Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) highlighted the importance of secondary risk factors associated with systemic diseases2. Systemic diseases can contribute to the development of DED through diverse mechanisms. Neuropathy, for example, as a result of diabetic neuropathy, or because of neurotoxic chemotherapy, can impact ocular surface innervation; autoimmune disorders such as Sjögren syndrome, lupus erythematosus, rheumatoid arthritis, systemic sclerosis and scleroderma, can target the lacrimal glands; and metabolic diseases, such as diabetes mellitus, thyroid disease and hyperlipidaemia, can have a multifaceted impact on the ocular surface. Additionally, other systemic conditions, including cardiovascular diseases, lymphoma, sarcoidosis, graft-versus-host disease, irritable bowel syndrome (IBS), Crohn’s disease and rosacea, have also been linked to DED3,4. Here, we focus on its neuropathic, autoimmune and metabolic risk factors.
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