This page is about dry eye in general. For the severe forms that scleral lenses are used for, see scleral lenses for severe dry eye and the conditions list.
Why the numbers vary so much
Dry eye disease isn’t one thing measured one way. The international Tear Film and Ocular Surface Society’s 2017 workshop (TFOS DEWS II) defined it as a multifactorial disease involving loss of tear film balance, with symptoms that can include discomfort or visual disturbance, and recognized that signs and symptoms don’t always go together.[2]
So studies count different things:
- A doctor’s diagnosis, found in survey answers or insurance codes.
- Symptoms, reported on a questionnaire.
- Signs, found in an eye exam, such as tear film instability or surface staining.
The TFOS DEWS II epidemiology review found that prevalence ranged from 5% to 50% across published studies. Signs were more common, and more variable, than symptoms.[1] Keep this in mind when comparing any two figures below: they are often measuring different things.
Worldwide
A 2021 analysis combined studies published between 1997 and 2021 using a Bayesian method. Its estimates show how much the definition matters:[3]
| Definition used | Estimated global prevalence[3] |
|---|---|
| Symptoms | 9.12% |
| All studies combined | 11.59% |
| TFOS DEWS II diagnostic criteria | 29.5% |
| Signs | 35.2% |
Prevalence also varied by region. For symptomatic dry eye, the estimate was lowest in North America (4.6%) and highest in Africa (47.9%). The author noted that data were sparse for young people and for every region except Eastern Asia.[3]
United States
Three large US studies used different populations and methods:
| Study | Who was counted | How | Overall estimate |
|---|---|---|---|
| National Health and Wellness Survey, 2013 | 75,000 adults, weighted to the US adult population | Self-reported diagnosis | 6.8%, about 16.4 million adults[4] |
| Military Health System, 2003–2015 | 9.7 million beneficiaries aged 2 to 80+ | Diagnosis codes and dry eye prescriptions | 5.28%[5] |
| Women’s Health Study | 39,876 women, adjusted to US women aged 50+ | Diagnosis or severe symptoms | 7.8%, about 3.23 million women[6] |
| Physicians’ Health Studies I and II | 18,596 and 6,848 men aged 50+, adjusted to US men | Diagnosis or severe symptoms | 4.34%, about 1.68 million men[7] |
These don’t add up to a single US total. They cover different ages and time periods and use different definitions.
Age
Every study agrees: dry eye becomes more common with age.
- In the 2013 national survey, diagnosed dry eye rose from 2.7% of adults aged 18 to 34 to 18.6% of those aged 75 and older.[4]
- In the military health data, prevalence rose from 0.20% in children and teens aged 2 to 17 to 11.66% in people aged 50 and older.[5]
- In the Women’s Health Study, it rose from 5.7% among women under 50 to 9.8% among those 75 and older.[6]
- In the Physicians’ Health Studies, it rose from 3.90% at ages 50 to 54 to 7.67% at 80 and older.[7]
The international review found that signs increased more per decade of age than symptoms did.[1]
Sex
Women are affected more often than men in most studies.
- US national survey: 8.8% of women (about 11.1 million) vs 4.5% of men (about 5.3 million).[4]
- Military health data: 7.78% of women vs 2.96% of men.[5]
- International review: women have a higher prevalence than men, but the difference becomes significant only with age.[1]
Other risk factors
The international review classed Asian ethnicity as a mostly consistent risk factor.[1] In the study of US men, high blood pressure, benign prostatic hyperplasia, and the use of antidepressants, blood pressure medicines, and prostate medicines were associated with higher risk.[7] The review also found the burden of dry eye on vision, quality of life, and work productivity to be considerable.[1]
Where scleral lenses come in
Scleral lenses aren’t a routine dry eye treatment. They’re used for severe ocular surface disease, usually after other treatments haven’t worked.
- They make up a minority of scleral fits. In a 2020 survey of 777 experienced fitters, a median of 10% of scleral lenses were fitted for ocular surface disease.[8] In an international survey describing 259 individual patients, 9% were fitted for ocular surface disease.[9]
- Fitters usually try other treatments first. In a survey of 778 scleral lens practitioners, lubricating drops were the most common first choice for ocular surface disease (63% ranked them first), followed by gland expression, prescription anti-inflammatory drops, steroids, and punctal plugs. Scleral lenses were generally considered after those but before surgery.[10]
- For those who need them, they can help. At one US tertiary center, people fitted with scleral lenses for ocular surface disease had tried an average of 3.2 other treatments first. Of the 115 who completed fitting, all but 2 met their treatment goals, such as better comfort, surface protection, or healing.[11]
There’s no reliable figure for how many people with dry eye have disease severe enough to need a scleral lens. If yours is severe and hasn’t responded to other treatment, ask your eye doctor whether a scleral lens evaluation makes sense.
Common questions
How many Americans have dry eye?
A 2013 national survey of 75,000 adults projected that 6.8% of US adults, about 16.4 million people, had been diagnosed with dry eye disease. Counting people with symptoms but no diagnosis would give a higher number.
Why do dry eye statistics vary so much?
Studies define dry eye differently. Some count people with a doctor's diagnosis, some count symptoms on a questionnaire, and some count signs found in an eye exam. Signs are found more often, and vary more, than symptoms. An international expert review found prevalence ranging from 5% to 50% across studies.
Is dry eye more common in women?
Yes, in most studies. In the 2013 US survey, 8.8% of women had a diagnosis compared with 4.5% of men. The international expert review found the difference between women and men becomes significant mainly with age.
Does dry eye get worse with age?
It becomes more common with age. In the US survey, diagnosed dry eye rose from 2.7% of adults aged 18 to 34 to 18.6% of those aged 75 and older.
How many people with dry eye need scleral lenses?
There isn't a reliable figure. Scleral lenses are generally reserved for severe ocular surface disease that hasn't responded to other treatments. In a 2020 survey of experienced fitters, a median of 10% of their scleral lenses were fitted for ocular surface disease.