A Study on Prevalence of Dry Eye Disease in Rural Area of Jharkhand and its Risk Factors and Its Association with Type 2 Diabetes Mellitus: An Observational Study

Abstract

Background: Dry eye disease (DED) is a multifactorial disorder of the tear film and ocular surface that leads to discomfort, visual disturbance, and tear film instability. Rural populations of tribal-dominated states such as Jharkhand face additional exposure to biomass smoke, dust, and ultraviolet radiation, while limited eye-care access delays diagnosis. Type 2 diabetes mellitus (T2DM), which is rising steadily even in rural India, has been proposed as an independent risk factor for DED due to autonomic denervation of the lacrimal gland and reduced corneal sensitivity. Objectives: The aim of this study was to determine the prevalence of DED among adults residing in a rural area of Jharkhand, to identify its associated risk factors, and to study its association with T2DM. Methods: A community-based cross-sectional observational study was carried out among 108 adults aged 30 years and above, selected by multistage random sampling from villages of a rural field-practice area. DED was diagnosed using the Ocular Surface Disease Index questionnaire supported by Schirmer’s test and tear film break-up time. Data were analyzed using the Statistical Package for the Social Sciences version 26; Chi-square test and odds ratio (OR) with 95% confidence interval (CI) were applied, with P < 0.05 taken as significant. Results: The overall prevalence of DED was 39.8% (43/108). Prevalence was significantly higher among known diabetics (60.0%) compared with non-diabetics (27.9%), with an OR of 3.87 (95% CI: 1.70–8.83, P < 0.01). Advancing age, longer duration of diabetes, poor glycemic control (glycosylated hemoglobin >7%), outdoor occupation, biomass fuel exposure, and prolonged screen use emerged as significant risk factors. Conclusion: DED is a common but under-recognized problem in rural Jharkhand and shows a strong, statistically significant association with T2DM. Integrating ocular surface screening into existing rural diabetes care programs is recommended.