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Original Research (Original Article) 


Maisa Alswilim et al, 2019;3(10):045–052.

International Journal of Medicine in Developing Countries

Prevalence of eye dryness among the general population of the Northern Region of Saudi Arabia

Maisa Alsweilem1*, Maram Khalf Alenzi2, Seba Naji Almutairi3, Thamer Abdullah Alanazy4

Correspondence to: Maisa Alsweilem

*Ophthalmology Consultant, Prince Abdulaziz bin Musaed Hospital, Arar, Saudi Arabia.

Email: dr.maisams [at] gmail.com

Full list of author information is available at the end of the article.

Received: 14 July 2019 | Accepted: 21 July 2019


ABSTRACT

Background:

Dry eye disease (DED) is one of the most frequently encountered ocular morbidities. 25% of patients who visit ophthalmic clinics report symptoms of dry eye, making it growing public health. This study estimated the prevalence of eye dryness and to determine the risk factors for dry eye in the general population in the Northern Region, Saudi Arabia.


Methodology:

This was a cross-sectional community-based study, conducted among 384 Saudi and non-Saudi males and females of 15 years of age and above, in Arar, the Northern region of Saudi Arabia, during the period from 1 November 2018 to 31 January 2019. The data were collected by using a predesigned questionnaire.


Results:

The prevalence of dry eye disease in the sample was 36.5%. Reported symptoms were feeling gritty or sandy sensation in the eye 36.3%, burning sensation 40.3%, and sometimes having red-eye 44.9%. Dry eye disease was more prevalent in females 76.9% than males 23.1% (p = 0.521), there was no significant relation with age (p = 0.66) and was more prevalent in 21–30 age group (46.2%). In cases with DED, there were 13.2% who wore contact lenses and 22.2% wore glasses (p = 0.004). There was insignificant relation with osteoporosis, joint or rheumatic problems, bronchial asthma, thyroid diseases, high blood cholesterol, hypertension, diabetes, and aspirin administration; however, it was positively associated with the previous history of trachoma.


Conclusion:

The prevalence of dry eye disease in this sample was 36.5%, with significant positive relation with wearing contact lenses and glasses, and previous history of trachoma.


Keywords:

Eye dryness, prevalence, risk factors, Northern Region, Saudi Arabia.


Introduction

Many eye diseases are well known to affect the individual's quality of life. Many factors have been established as causative factors for eye disorders including the geographical, economic, social, environmental hazards, and trauma. Furthermore, both age and gender play an essential role in the incidence of many eye diseases. Many diseases affect the eye such as cataracts, diabetic retinopathy, macular degeneration refractive errors, glaucoma, and eye dryness [1].

Dry eye disorder is amongst the most prevalent disorders present in the ophthalmology clinic. It is a multifactorial disorder of tear film. The etiology of the disorder is known to be caused by tear deficiency or excessive tear evaporation [2,3]. Tear deficiency develops when the meibomian gland, lacrimal gland, and goblet cells are affected which leads to decreased tear volume. On the other hand, in case of the tears’ rapid evaporation, the tears’ volume is normal but tear film is abnormal [4].

Eye dryness coexists with the increased osmolarity of the tear film and inflammation of the ocular surface [58]. This, in turn, results in symptoms of sandy-gritty irritation, burning eyes, blurred vision, eye fatigue and foreign body sensation which affect one’s quality of life [9]. Also, evidence has shown that people with dry eyes are more susceptible to infection and ulceration of the cornea [10].

Many factors have a major role in the disease amongst these are age, smoking, prolonged periods in front of computer screens, and wearing contact lenses. The risk is also higher amongst females due to the hormonal changes they experience, and individuals who have undergone laser eye surgery. Furthermore, dry eye is also associated with systemic diseases, such as diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, and thyroid disease [4].

In Saudi Arabia, there was a study conducted in Al-Ahsa with a sample size of 1,858 Saudi adults, it showed that the prevalence of eye dry syndrome accounts for 32.1% of their sample [11]. In another study conducted in Taif, a population of 482 patients resulted in different ranges of eye dryness including mild, moderate, and severe with percentages of 21.4%, 12.9%, and 41.7%, respectively [3]. Furthermore, out of 251 people in a study conducted in Jeddah, 234 of them had eye dryness which represented 93.2% [12]. Also, in a case series study done in Riyadh region, reported that 62 patients with dry eye showed that there is a prevalence and association of their condition with other chronic diseases [13].

This study aimed to estimate the prevalence and the determinant factors of eye dryness in the general population of the Northern region, Saudi Arabia.


Subjects and Methods

This study was based on a community-based crosssectional survey in the Northern Region of Saudi Arabia, during the period from 1 November 2018 to 31 January 2019. Both genders, all nationalities, of age 15 and above who lived in the northern region were included in the study.

Sample size was calculated by using Raosoft [14] sample size calculator, with a population size of around 189,359, 5% as a margin of error, 95% confidence interval, and 50% as the response distribution, the minimum calculated sample size was 384. A systematic random sampling technique was used in this study.

Data were collected by using a predesigned questionnaire. The questionnaire was divided into two sections; the first section was concerned with information of participants, while the second section evaluated the symptoms of eye dryness. The questionnaire included demographic data and other sets of valid questions. The questions included the following items: age, gender, nationality, comorbidities, and current treatment/medications, smoking. The soft copy questionnaire was designed using Google form website. The link of the soft copy of the questionnaire was distributed mainly using the messaging applications. The questionnaire was posted in the Arabic language. The questionnaire was tested and validated previously by the researchers from Al-Ahsa [11].

The data were entered in Microsoft Excel TM and then exported to SPSSTM version 22 for analysis. The data was then reviewed and cleaned for analysis. For frequency, percentages and categorical data descriptive statistics were used. Also, for the comparisons, a Chisquare test was used. For the test applied p-value < 0.05 was considered as significant.


Results

In this research, the total sample was 581 with 135 (23.2%) males and 446 (76.8%) females. Saudi participants accounted for 98.8%. The population age ranged from 15 to 65 with a fair distribution, with a mean age 29.6 years. Among the respondents, 38.9% were working, 12.9% suffered from dry eyes, whereas 30.8% never felt dryness symptoms, 12% of the participants wore contact lenses, 16.2% wore glasses, and 63% did not wear any of them. 39% percent of the participants used vitamins and supplements, 14.3% used omega-3, and 7.6% took aspirin. 76.1% consumed caffeine daily, while 1.4% never consumed caffeine (Table 1).

The result showed that 12.4% used contact lenses, 16.2% used glasses, 8.4% used both glasses and contact lenses, while most of the participants had normal vision without the use of glasses and contact lenses 63% (p value = 0.004). 9% of the participants had have LASIK surgery before (p value = 0.00).

Table 1. Socio-demographic characteristics and history of ever feeling dry eyes among studied participants, Arar, KSA, 2018(N = 581).

Socio-demographic characteristics Frequency Percent
Gender
Male 135 23.2
Female 446 76.8
Age group
<21 92 15.8
21–30 249 42.9
31–40 179 30.8
>40 61 10.5
Mean age (±SD) 29.6 (±8.7)
Work status
Work (field) 126 21.7
Work (office) 100 17.2
Retired 9 1.5
Student 164 28.2
No job 182 31.3
Nationality
Saudi 574 98.8
Non-Saudi 7 1.2
History of ever feeling dry eyes
Constantly (all the time) 75 12.9
Often (at least once a week) 137 23.6
Sometimes (once in 2–4 weeks) 190 32.7
No 179 30.8

The participants had difficulty in going to air conditioned places (33.0%, p value = 0.000), areas with low humidity (34.3%, p value = 0.000), and being exposed to stormy atmosphere (65.6%, p value = 0.000). Furthermore, the participants reported that they have difficulty watching TV or mobile (39.6%, p value = 0.008), using computer (28.6%, p value = 0.173), driving the car or looking at a distance at night (25%, p value = 0.18) and continuous reading (25.8%, p value = 0.043) (Table 2).

Table 2. Association between dry eye disease and suspected risk factors among studied participants, Arar, KSA, 2018(N = 581).

Variables Responses Eye dryness Total (n = 581) p value
Positive (n = 212) Negative (n = 369)
Watching TV or mobile No 114 237 351 0.008
53.80% 64.20% 60.40%
Yes 98 132 230
46.20% 35.80% 39.60%
Using computer No 146 269 415 0.173
68.90% 72.90% 71.40%
Yes 66 100 166
31.10% 27.10% 28.60%
Continues reading No 148 283 431 0.043
69.80% 76.70% 74.20%
Yes 64 86 150
30.20% 23.30% 25.80%
Using Omega-3 (fish oil) No 183 315 498 0.426
86.30% 85.40% 85.70%
Yes 29 54 83
13.70% 14.60% 14.30%
Aspirin administration No 192 345 537 0.131
90.60% 93.50% 92.40%
Yes 20 24 44
9.40% 6.50% 7.60%
Using vitamins or supplements No 121 230 351 0.123
57.10% 62.30% 60.40%
Yes 91 139 230
42.90% 37.70% 39.60%
LASIK No 180 346 526 0
84.90% 94.00% 90.70%
Yes 32 22 54
15.10% 6.00% 9.30%
Wearing glasses and/or contact lenses Contact lenses 28 44 72 0.004
13.20% 11.90% 12.40%
Glasses 47 47 94
22.20% 12.70% 16.20%
Glasses and contact lenses 22 27 49
10.40% 7.30% 8.40%
Don’t wear 115 251 366
54.20% 68.00% 63.00%
Attending places with air conditioning No 102 287 389 0
48.10% 77.80% 67.00%
Yes 110 82 192
51.90% 22.20% 33.00%
Attending areas of low humidity (very dry) No 101 281 382 0
47.60% 76.20% 65.70%
Yes 111 88 199
52.40% 23.80% 34.30%
Exposure to the stormy atmosphere No 45 155 200 0
21.20% 42.00% 34.40%
Yes 167 214 381
78.80% 58.00% 65.60%
Consuming caffeine (coffee or tea) daily 171 271 442 0.128
80.70% 73.40% 76.10%
weekly 17 38 55
8.00% 10.30% 9.50%
rarely 20 56 76
9.40% 15.20% 13.10%
never 4 4 8
1.90% 1.10% 1.40%
Driving the car or looking for a distance during the night No 154 282 436 0.18
72.60% 76.40% 75.00%
Yes 58 87 145
27.40% 23.60% 25.00%

For chronic diseases, it was found that 15.8% of the participants had rheumatic diseases and 10.7% had thyroid diseases. Also, they reported other diseases, such as bronchial asthma, diabetes, hypertension, dyslipidemia, osteoporosis, and trachoma with the percentages of 6%, 5.9%, 4.5%, 4.5%, 4.3%, and 3.6%, respectively. There was no significant correlation between chronic diseases and dry eye disease except for trachoma (p value = 0.04) (Table 3).

The result showed that 27 (4.6%) of participants complained of gritty or sandy sensation, 49 (8.4%) had a burning sensation, 29(5%) had a red eye, 20 (3.4%) had crusting on eye lashes, 97 (16.7) had sensitivity to light, 1 (0.2%) had frequent ulcers (corneal wounds), and 63 (10.8) suffered from change or fluctuation in vision. 9% of the respondents reported their usage of the eye drops either for therapeutic reasons or for their eye dryness. Among those who used the eye drops, 60.1% did not use it frequently, 22.9% used it with doctor prescription, and 17% used it without prescription (Table 4).


Discussion

Dry eye disease (DED) is one of the foremost encountered ocular morbidities. 25% patients who visit ophthalmic clinics report symptoms of dry eye, creating it a growing public pathological state and one in every of the foremost common conditions seen by eye care practitioners [15]. The International Dry Eye Workshop defines ocular dryness as a multifactorial disease of tears and ocular surface that causes symptoms of discomfort, visual disturbance, and instability of the tear film with potential lesions of the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface [16]. Even though this condition rarely leads to loss of vision, it may reduce the quality of life when its symptoms occur. Eye dryness is primarily caused by an aqueous deficiency, excessive lacrimal film evaporation, or combination of both. Various populationbased studies have sought to measure the prevalence of DES and the associated risk factors. However, the risk factors for DES vary with genetic factors, cultures, living environment, and lifestyles prevalent in different regions [1719].

It was found in the present study that 36.5% of the sample had dry eye disease. This was near to another study conducted in Al-Ahsa city among 1858 Saudi adults which reported the prevalence of DES was 32.1% [11]. However, another study was conducted in the coastal population of the eastern province in Saudi Arabia, which reported that the prevalence of symptomatic dry eye was 62.4% [20]. Also, Nita et al. [21], found that out of the 237 patients who presented with standard symptoms of dry eye, 63% were diagnosed positive for the illness. In Kuantan, Malaysia, another study conducted among 643 patients reported that the prevalence of DED was 48.8% [22]. In Uttarakhand, India, an observational study of 503 patients who were screened for dry eye reported that the prevalence osf dry eye was found to be 46.71% [23]. In southern Egypt, a cross-sectional, observational, hospital-based study of 3,128 patients was conducted; dry eye disease prevalence was 22.8% [24]. This was similar to another study conducted in Manila, Philippines among 148 participants from them (22.9%) had dry eye disease [25]. In Mexico, a cross-sectional populationbased study that included 1508 individuals aged ≥50 years found that the prevalence of DES was 41.1% [26].

Table 3. Association between dry eye disease and suspected diseases affecting it among studied participants, Arar, KSA, 2018(N = 581).

Variables Responses Eye dryness Total (n = 581) p value
Positive (n = 212) Negative (n = 369)
Previous history of trachoma No 200 360 560 0.04
94.3% 97.6% 96.4%
Yes 12 9 21
5.7% 2.4% 3.6%
Osteoporosis No 202 354 556 0.430
95.3% 95.9% 95.7%
Yes 10 15 25
4.7% 4.1% 4.3%
Joint or rheumatic problems No 168 312 480 0.083
81.2% 86.0% 84.2%
Yes 39 51 90
18.8% 14.0% 15.8%
Bronchial asthma No 197 349 546 0.263
92.9% 94.6% 94.0%
Yes 15 20 35
7.1% 5.4% 6.0%
Thyroid diseases No 185 334 519 0.140
87.3% 90.5% 89.3%
Yes 27 35 62
12.7% 9.5% 10.7%
High blood cholesterol No 202 353 555 0.491
95.3% 95.7% 95.5%
Yes 10 16 26
4.7% 4.3% 4.5%
Hypertension No 202 353 555 0.491
95.3% 95.7% 95.5%
Yes 10 16 26
4.7% 4.3% 4.5%
Diabetes No 195 352 547 0.068
92.0% 95.4% 94.1%
Yes 17 17 34
8.0% 4.6% 5.9%

Several risk factors for the development of DED have been identified repeatedly in epidemiological studies, such as increasing age and female sex. Hormonal studies suggested that sex hormones influence ocular surface conditions through their effects on tear secretions, meibomian gland function, and conjunctival goblet cell density [27].

The present study found that dry eye disease was more prevalent in females 76.9%, than males 23.1% without significant correlation (p = 0.521), also, there was no significant correlation with age (p = 0.66) and was more prevalent in 21–30 age group by 46.2%. Similar to the present result a prospective-based study was carried out among 251 people of Jeddah, Saudi Arabia. Based on interview and dry eye symptoms, the factors associated with dry eyes were established. No significant association with gender and age was found [12]. Another study found that the prevalence of dry eye was found to be maximum in the elderly, it was 67.3% in participants aged 71 years and above, 51% males and 57.2% females had dry eye disorder. This depicts a higher prevalence of dry eye disorder among the female population [28]. In contrast to the present result, another study showed that female gender (p = 0.001), older age (p = 0.012) were associated with a significantly higher likelihood for DESs often or constantly [11].

Table 4. Dry eye disease related conditions among the studied participants, Arar, KSA, 2018 (N = 581).

No. %
History of ever feeling a gritty or sandy sensation in the eye
Sometimes (once in 2–4 weeks) 211 36.3
Often (at least once a week) 92 15.8
Constantly (all the time) 27 4.6
No 251 43.2
History of ever having a burning sensation in the eyes
Sometimes (once in 2–4 weeks) 234 40.3
Often (at least once a week) 113 19.4
Constantly (all the time) 49 8.4
No 185 31.8
History of ever having a red eye
Sometimes (once in 2–4 weeks) 261 44.9
Often (at least once a week) 105 18.1
Constantly (all the time) 29 5.0
No 186 32.0
History of ever having much crusting on eye lashes
Sometimes (once in 2–4 weeks) 85 14.6
Often (at least once a week) 30 5.2
Constantly (all the time) 20 3.4
No 446 76.8
History of ever feeling eyes sensitivity to light
Sometimes (once in 2–4 weeks) 216 37.2
Often (at least once a week) 93 16.0
Constantly (all the time) 97 16.7
No 175 30.1
History of frequent ulcers (corneal wounds)
Sometimes (once in 2–4 weeks) 27 4.6
Often (at least once a week) 6 1.0
Constantly (all the time) 1 0.2
No 547 94.1
Suffering from change or fluctuation in vision
Sometimes (once in 2–4 weeks) 194 33.4
Often (at least once a week) 64 11.0
Constantly (all the time) 63 10.8
No 260 44.8
Using of any eye drops
Sometimes (once in 2–4 weeks) 108 18.6
Often (at least once a week) 38 6.5
Constantly (all the time) 55 9.5
No 380 65.4
Cause of using; for a therapeutic reason or for the dryness
Without prescription 99 17.0
With doctor prescription 133 22.9
Don’t use frequently 349 60.1

From other factors affecting dry eye disease, wearing glasses or contact lenses, the present study reported that in cases with DED, there were 13.2% wearing contact lenses and 22.2% wearing glasses with positive significant correlation (p = 0.004). Contact lens wearers are also five times more susceptible to dry eye than glasses wearers [29]. Another study reported that dry eye symptoms were positively associated with contact lens (p = 0.04) and wearers had a 3.4 times higher risk of developing dry eye symptoms than non-wearers [22]. This was consistent with a previous epidemiological study from Singapore [29], which found that wearing contact lenses increased the risk of dry eye symptoms 2.9 times. However, Alshamrani et al. [6] reported that wearing contact lenses was not found to be significantly associated with DESs.

Regarding the association between dry eye disease and suspected diseases affecting it, it was found in the present study that there was no significant correlation with osteoporosis, joint or rheumatic problems, bronchial asthma, thyroid diseases, high blood cholesterol, hypertension, diabetes, and aspirin administration, however, it was positively associated with previous history of trachoma. Another study reported no significant correlation between DED and history of trachoma, hypertension, bronchial asthma, thyroid disease, arthritis, hemolytic blood diseases (sickle cell-thalassemia), gout, and osteoporosis [11]. A population-based cohort study conducted by Moss, found that arthritis and hypercholesterolemia were significantly associated with dry eye [18].

Symptoms of burning sensation, dryness, and stickiness were the most prevalent among dry eye patients. This study reported complains of feeling a gritty or sandy sensation in the eye (36.3%), burning sensation (40.3%) and sometimes having red-eye (44.9%). Another study reported that watery eyes was the most common complaint (41%), followed by itching sensation (19.8%), and burning (14.7%) [30]. Another study found that most frequent DES among the study population was grittiness (21.3%), followed by burning (20.9%), redness (17.8%), crusts (14.9%), dryness (13.5%), and stuck shut (11.6%) [11].

This study used a predesigned questionnaire to study DESs like that used in other population-based studies, this marks the strength of the study. Whereas the limitations were that this study was depended on an online disseminated questionnaire, the history of previous diagnosis and presence of symptoms, the authors did not perform the clinical tests to identify dry eye due to the busy clinics and shortage of centers and well trained specialists in the region to help in the clinical diagnosis.


Conclusion

In this study, the prevalence of dry eye disease was 36.5% that was higher than other similar studies in other regions. This percentage had a positive significant relation with wearing contact lenses and glasses, and previous history of trachoma. Further research including clinical tests to confirm the diagnosis of dry eye is needed.


List of Abbreviations

DES Dry eye syndrome
DED Dry eye disease

Conflict of interest

The authors declared that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Ethical approval was granted by Ethics Committee, King Abdulaziz bin Musaed Hospital, Arar, Northern Border Region, via letter number 12/1440, dated 14/12/2018.


Author details

Maisa Alsweilem1, Maram Khalf Alenzi2, Seba Naji Almutairi3, Thamer Abdullah Alanazy4

  1. Ophthalmology Consultant, Prince Abdulaziz bin Musaed Hospital, Arar, Saudi Arabia
  2. College of Medicine, Northern Border University, Arar, Saudi Arabia
  3. College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
  4. College of Medicine, Jouf University, Skaka, Saudi Arabia

References

  1. Reddy S, Tajunisah I, Low K, Karmila A. Prevalence of eye diseases and visual impairment in urban population—a study from University of Malaya Medical Centre. Malays Fam Physician. 2008;3:25–8.
  2. Lemp M. Report of the National Eye Institute/Industry workshop on clinical trials in dry eyes. CLAO J. 1995;21:221–32.
  3. Alzahrani A, Alhamyani A, Noor Kalakattawi R, Noor Kalakattawi A, Alhamyani A, Alsuqati F, et al. Prevalence of dry eye symptoms and its risk factors among patients of King Abdulaziz Specialist Hospital (Taif), Saudi Arabia. SJHS. 2017;6:140. https://doi.org/10.4103/sjhs.sjhs_90_17
  4. Javadi M, Feizi S. Dry eye syndrome. J Ophthalmic Vis Res. 2011;6:192–8.
  5. Farris R, Stuchell R, Mandel I. Tear osmolarity variation in the dry eye. Trans Am Ophthalmol Soc. 1986;84:250–68.
  6. Tomlinson A, Khanal S, Ramaesh K, Diaper C, McFadyen A. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006;47:4309–15. https://doi.org/10.1167/iovs.05-1504
  7. Pflugfelder S, Jones D, Ji Z, Afonso A, Monroy D. Altered cytokine balance in the tear fluid and conjunctiva of patients with Sjögren's syndrome keratoconjunctivitis sicca. Curr Eye Res. 1999;19:201–11. https://doi.org/10.1076/ceyr.19.3.201.5309
  8. Tsubota K, Fujihara T, Saito K, Takeuchi T. Conjunctival epithelium expression of HLA-DR in dry eye patients. Ophthalmologica. 1999;213:16–9. https://doi.org/10.1159/000027387
  9. Galor A, Levitt R, Felix E, Sarantopoulos C. Understanding the true burden of dry eye disease. Expert Rev Ophthalmol. 2015;10:403–5. https://doi.org/10.1586/17469899.2015.1061431
  10. Complications of dry eye syndrome—HSE.ie [Internet]. HSE.ie. 2018 [cited 2019 Apr 17]. Available from: https://www.hse.ie/eng/health/az/d/dry-eye-syndrome/complications-of-dry-eye-syndrome.html
  11. Alshamrani A, Almousa A, Almulhim A, Alafaleq A, Alosaimi M, Alqahtani A, et al. Prevalence and risk factors of dry eye symptoms in a Saudi Arabian population. Middle East Afr J Ophthalmol. 2017;24:67–73. https://doi.org/10.4103/meajo.MEAJO_281_16
  12. Bukhari A, Ajlan R, Alsaggaf H. Prevalence of dry eye in the normal population in Jeddah, Saudi Arabia. Orbit. 2009;28:392–7. https://doi.org/10.3109/01676830903074095
  13. Al Houssien A, Al Houssien R, Al-Hawass A. Magnitude of diabetes and hypertension among patients with dry eye syndrome at a tertiary hospital of Riyadh, Saudi Arabia—a case series. Saudi J Ophthalmol. 2017;31:91–4. https://doi.org/10.1016/j.sjopt.2017.02.001
  14. [Internet]. Worldpopulationreview.com. 2018 [cited 2019 Apr 17]. Available from: http://worldpopulationreview.com/countries/saudi-arabia-population/
  15. O'Brien P, Collum L. Dry eye: diagnosis and current treatment strategies. Curr Allergy Asthma Rep. 2004;4:314–9. https://doi.org/10.1007/s11882-004-0077-2
  16. The definition and classification of dry eye disease: report of the definition and classification subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007;5:75–92. https://doi.org/10.1016/S1542-0124(12)70081-2
  17. Chia E, Mitchell P, Rochtchina E, Lee A, Maroun R, Wang J. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Exp Ophthalmol. 2003;31:229–32. https://doi.org/10.1046/j.1442-9071.2003.00634.x
  18. Moss S, Klein R, Klein B. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol. 2000;118:1264–8. https://doi.org/10.1001/archopht.118.9.1264
  19. Imam S, Elagin R, Jaume J. Diabetes-associated dry eye syndrome in a new humanized transgenic model of type 1 diabetes. Mol Vis. 2013;19:1259–67.
  20. Alharbi A, Alanazi N, Alhamad J, Alabdulqader R, Aljamea D, Alabdulqader S, et al. Prevalence of symptomatic dry eye and its risk factors among coastal population in eastern province of Saudi Arabia. J Clin Exp Ophthalmol. 2018;9:34.
  21. Nita S, Verghese A, Joseph V. Dry eye—a hospital based incidence study. Kerala J Ophthalmol. 2009;21:396–401.
  22. Abd Rahman A, Aljarousha M, Badarudin N, Che Azemin M, Awad K. Prevalence and risk factors of dry eye disease in Kuantan, Malaysia. Makara J Health Res. 2018;22:27–33. https://doi.org/10.7454/msk.v22i1.8749
  23. Baisoya P, Raj A, Bahadur H, Nagpal R. The prevalence and clinical profile of dry eye in tertiary hospital based normal healthy population in Uttarakhand, India. IJCMPH. 2016;3:2521–6. https://doi.org/10.18203/2394-6040.ijcmph20163065
  24. Mostafa E. Prevalence of dry eye disease in southern Egypt: a hospital-based outpatient clinic study. J Egypt Ophthalmol Soc. 2016;109:32. https://doi.org/10.4103/2090-0686.192749
  25. Panggat K, Covar R, Siong R. Prevalence of dry eye disease in an urban community. Philipp J Ophthalmol. 2015;40:29–35.
  26. Graue-Hernández E, Serna-Ojeda J, Estrada-Reyes C, Navas A, Arrieta-Camacho J, Jiménez-Corona A. Dry eye symptoms and associated risk factors among adults aged 50 or more years in Central Mexico. SaludPública de México. 2018;60:520. https://doi.org/10.21149/9024
  27. Gayton J. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol. 2009;3:405–12. https://doi.org/10.2147/OPTH.S5555
  28. Shah S, Jani H. Prevalence and associated factors of dry eye: Our experience in patients above 40 years of age at a Tertiary Care Center. Oman J Ophthalmol. 2015;8:151–6. https://doi.org/10.4103/0974-620X.169910
  29. Nichols J, Sinnott L. Tear film, contact lens, and patient-related factors associated with contact lens-related dry eye. Invest Ophthalmol Vis Sci. 2006;47:1319–28. https://doi.org/10.1167/iovs.05-1392
  30. Tan L, Morgan P, Cai Z, Straughan R. Prevalence of and risk factors for symptomatic dry eye disease in Singapore. Clin Exp Optom. 2015;98:45–53. https://doi.org/10.1111/cxo.12210


How to Cite this Article
Pubmed Style

Mashrah HT, Alghamdi RS, Faydh AA, Althobati NE, Alosimi FS, Alqurashi MM, Alswat HK, Elnemr GM. Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. IJMDC. 2019; 3(11): 45-51. doi:10.24911/IJMDC.51-1566748654


Web Style

Mashrah HT, Alghamdi RS, Faydh AA, Althobati NE, Alosimi FS, Alqurashi MM, Alswat HK, Elnemr GM. Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. http://www.ijmdc.com/?mno=62683 [Access: November 22, 2019]. doi:10.24911/IJMDC.51-1566748654


AMA (American Medical Association) Style

Mashrah HT, Alghamdi RS, Faydh AA, Althobati NE, Alosimi FS, Alqurashi MM, Alswat HK, Elnemr GM. Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. IJMDC. 2019; 3(11): 45-51. doi:10.24911/IJMDC.51-1566748654



Vancouver/ICMJE Style

Mashrah HT, Alghamdi RS, Faydh AA, Althobati NE, Alosimi FS, Alqurashi MM, Alswat HK, Elnemr GM. Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. IJMDC. (2019), [cited November 22, 2019]; 3(11): 45-51. doi:10.24911/IJMDC.51-1566748654



Harvard Style

Mashrah, H. T., Alghamdi, . R. S., Faydh, . A. A., Althobati, . N. E., Alosimi, . F. S., Alqurashi, . M. M., Alswat, . H. K. & Elnemr, . G. M. (2019) Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. IJMDC, 3 (11), 45-51. doi:10.24911/IJMDC.51-1566748654



Turabian Style

Mashrah, Hosam Talal, Raed Saeed Alghamdi, Abdulaziz Amin Faydh, Nawaf Eidhah Althobati, Faisal Sultan Alosimi, Mona Modhef Alqurashi, Hameed Khashiban Alswat, and Gamal Mohamed Elnemr. 2019. Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. International Journal of Medicine in Developing Countries, 3 (11), 45-51. doi:10.24911/IJMDC.51-1566748654



Chicago Style

Mashrah, Hosam Talal, Raed Saeed Alghamdi, Abdulaziz Amin Faydh, Nawaf Eidhah Althobati, Faisal Sultan Alosimi, Mona Modhef Alqurashi, Hameed Khashiban Alswat, and Gamal Mohamed Elnemr. "Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus." International Journal of Medicine in Developing Countries 3 (2019), 45-51. doi:10.24911/IJMDC.51-1566748654



MLA (The Modern Language Association) Style

Mashrah, Hosam Talal, Raed Saeed Alghamdi, Abdulaziz Amin Faydh, Nawaf Eidhah Althobati, Faisal Sultan Alosimi, Mona Modhef Alqurashi, Hameed Khashiban Alswat, and Gamal Mohamed Elnemr. "Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus." International Journal of Medicine in Developing Countries 3.11 (2019), 45-51. Print. doi:10.24911/IJMDC.51-1566748654



APA (American Psychological Association) Style

Mashrah, H. T., Alghamdi, . R. S., Faydh, . A. A., Althobati, . N. E., Alosimi, . F. S., Alqurashi, . M. M., Alswat, . H. K. & Elnemr, . G. M. (2019) Prevalence of Thyroid disorders among patients with Type One Diabetes Mellitus. International Journal of Medicine in Developing Countries, 3 (11), 45-51. doi:10.24911/IJMDC.51-1566748654