Association of Dry Eye Severity with Headache of Unknown Etiology and Comparative Treatment Outcomes
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Background: Dry eye disease and headache disorders commonly coexist and may share trigeminal sensory pathways, but their clinical relationship and comparative response to ocular lubricants remain insufficiently characterized. Objective: To assess the association between dry-eye symptom severity and headache-related disability and compare four-week treatment outcomes between Systane Ultra and Vismed. Methods: This randomized comparative clinical trial included 104 adults aged 18–45 years with symptomatic dry eye disease and headache of initially undetermined etiology. Participants were allocated equally to Systane Ultra or preservative-free Vismed 0.18% sodium hyaluronate, administered four times daily for four weeks. Dry-eye assessment included OSDI, TBUT, and Schirmer’s I test, while headache-related disability was assessed using HIT-6. Paired and independent-samples t-tests and Spearman correlation were applied. Results: The reported clinical symptom score decreased from 12.4 ± 2.1 to 7.2 ± 1.5 with Systane Ultra and from 12.1 ± 1.9 to 8.5 ± 1.8 with Vismed (p < 0.001 for both). Mean improvement was greater with Systane Ultra than with Vismed (5.2 ± 1.1 versus 3.6 ± 1.4; mean difference, 1.60; 95% CI, 1.11–2.09; p < 0.001; Cohen’s d = 1.27). OSDI and HIT-6 scores were positively correlated (rₛ = 0.648; p = 0.001). Conclusion: Greater dry-eye symptom severity was associated with greater headache-related disability, and both lubricants improved the reported symptom score, with greater improvement observed for Systane Ultra
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1. Stapleton F, Velez FG, Lau C, Wolffsohn JS. Dry eye disease in the young: a narrative review. Ocul Surf. 2024;31:11–20.
2. Sánchez-González JM, Silva-Viguera C, Sánchez-González MC, Capote-Puente R, De-Hita-Cantalejo C, Ballesteros-Sánchez A, et al. Tear film stabilization and symptom improvement in dry eye disease: the role of hyaluronic acid and trehalose eyedrops versus carmellose sodium. J Clin Med. 2023;12(20):6647.
3. Liu S, Dong H, Fang S, Zhang L. Risk of dry eye in headache patients: a systematic review and meta-analysis. Ann Med. 2022;54(1):2864–2873.
4. Ismail OM, Poole ZB, Bierly SL, Van Buren ED, Lin FC, Meyer JJ, et al. Association between dry eye disease and migraine headaches in a large population-based study. JAMA Ophthalmol. 2019;137(5):532–536.
5. Tsubota K. Short tear film breakup time-type dry eye. Invest Ophthalmol Vis Sci. 2018;59(14):DES64–DES70.
6. Kim M, Lee Y, Mehra D, Sabater AL, Galor A. Dry eye: why artificial tears are not always the answer. BMJ Open Ophthalmol. 2021;6(1).
7. Isa NA, Krishnan AV, Zagami AS, Tummanapalli SS, Spira K, Papas EB, et al. A randomized crossover trial: the impact of ocular lubrication on migraine severity in persons with dry eye disease and migraine. Optom Vis Sci. 2022.
8. Koktekir BE, Celik G, Karalezli A, Kal A. Dry eyes and migraines: is there really a correlation? Cornea. 2012;31(12):1414–1416.
9. Sarac O, Kosekahya P, Yildiz Tasci Y, Keklikoglu HD, Deniz O, Erten Ş, et al. The prevalence of dry eye and Sjögren syndrome in patients with migraine. Ocul Immunol Inflamm. 2017;25(3):370–375.
10. Altas M, Oltulu P, Belviranli S, Uca AU, Gündogan AO, Mirza E, et al. Conjunctival impression cytology and dry eye parameters in migraine patients. Neurol India. 2026;74(2):249–255.
11. Miyake H, Kawano Y, Tanaka H, Iwata A, Imanaka T, Nakamura M. Tear volume estimation using a modified Schirmer test: a randomized, multicenter, double-blind trial comparing 3% diquafosol ophthalmic solution and artificial tears in dry eye patients. Clin Ophthalmol. 2016;10:879–886.
12. Lee CJ, Felix ER, Levitt RC, Eddy C, Vanner EA, Feuer WJ, et al. Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans. Br J Ophthalmol. 2018;102(5):667–673.
13. Ngo W, Srinivasan S, Houtman D, Jones L. The relief of dry eye signs and symptoms using a combination of lubricants, lid hygiene and ocular nutraceuticals. J Optom. 2017;10(1):26–33.
14. Yang YJ, Lee WY, Kim YJ, Hong YP. A meta-analysis of the efficacy of hyaluronic acid eye drops for the treatment of dry eye syndrome. Int J Environ Res Public Health. 2021;18(5):2383.
15. Jerkins G, Greiner JV, Tong L, Tan J, Tauber J, Mearza A, et al. A comparison of efficacy and safety of two lipid-based lubricant eye drops for the management of evaporative dry eye disease. Clin Ophthalmol. 2020;14:1665–1673.
16. Vogel R, Crockett RS, Oden N, Laliberte TW, Molina L, Sodium Hyaluronate Ophthalmic Solution Study Group. Demonstration of efficacy in the treatment of dry eye disease with 0.18% sodium hyaluronate ophthalmic solution. Am J Ophthalmol. 2010;149(4):594–601.
17. Tong L, Htoon HM, Hou A, Acharya UR, Tan JH, Wei QP, et al. Acupuncture and herbal formulation compared with artificial tears alone: evaluation of dry eye symptoms and associated tests in a randomised clinical trial. BMJ Open Ophthalmol. 2018;3(1).
18. Ang BC, Sng JJ, Wang PX, Htoon HM, Tong LH. Sodium hyaluronate in the treatment of dry eye syndrome: a systematic review and meta-analysis. Sci Rep. 2017;7(1):9013.
19. Johnson ME, Murphy PJ, Boulton M. Effectiveness of sodium hyaluronate eyedrops in the treatment of dry eye. Graefes Arch Clin Exp Ophthalmol. 2006;244(1):109–112.
20. Semp DA, Beeson D, Sheppard AL, Dutta D, Wolffsohn JS. Artificial tears: a systematic review. Clin Optom (Auckl). 2023;15:9–27.
21. Farhangi M, Diel RJ, Buse DC, Huang AM, Levitt RC, Sarantopoulos CD, et al. Individuals with migraine have a different dry eye symptom profile than individuals without migraine. Br J Ophthalmol. 2020;104(2):260–264.