Dry eye disease (DED) is a multifactorial disorder of the ocular surface characterized by loss of tear film homeostasis, accompanied by ocular symptoms in which tear film instability, hyperosmolarity, inflammation, ocular surface damage, and neurosensory abnormalities play important etiologic roles [1,2]. It is no longer regarded as a minor irritation alone; rather, it is a clinically important chronic condition that influences visual performance, reading, digital work, sleep quality, and overall quality of life [5]. Disturbance of the tear film and ocular surface can produce a broad symptom complex that includes dryness, burning, foreign body sensation, itching, fluctuating vision, reflex tearing, and intolerance to environmental stressors [2,3].

DED has emerged as a substantial public health concern because of its high prevalence across diverse populations and its rising recognition in general and specialist ophthalmic practice [4]. Epidemiological studies have shown wide variation in prevalence, largely because of differences in study design, diagnostic criteria, geography, climate, age structure, and health-seeking behavior [4,7,8]. Community-based and hospital-based studies consistently show that advancing age and female sex are important demographic correlates, while environmental irritants, reduced blink rate, prolonged visual display terminal exposure, contact lens use, systemic disease, and certain medications contribute to disease burden [4,7-13]. In contemporary practice, digital screen exposure has become particularly relevant because sustained attention during device use reduces blink frequency and destabilizes the tear film [3,9,10].

The clinical spectrum of DED ranges from mild episodic symptoms to persistent ocular surface disease with measurable tear deficiency or tear film instability [1,6]. Diagnosis therefore depends on careful symptom elicitation combined with objective examination. Commonly used assessments include Schirmer’s test for tear secretion, tear film break-up time (TBUT) for tear film stability, and corneal fluorescein staining for ocular surface epithelial compromise [6]. Although advanced diagnostic platforms are increasingly available, these conventional methods remain practical and clinically useful in resource-constrained outpatient settings. Understanding how symptoms and basic test abnormalities present in routine hospital practice is important for early recognition, counseling, and treatment planning [6,14].

Indian data also indicate a considerable burden of DED in both hospital and large database settings, with notable contributions from occupational exposure, urban lifestyle, and digital device use [12,13]. Nevertheless, institution-specific information from outpatient departments remains valuable because the profile of patients differs according to local climate, service utilization, and sociobehavioral factors. Rajanna Sircilla district has a mixed urban-rural population in which changing screen habits, environmental exposure, and systemic comorbidity can influence ocular surface health. The present study was undertaken to describe the pattern of dry eye disease among adults attending an ophthalmology outpatient department and to assess the distribution of selected risk factors, symptoms, and clinical test findings in this setting.

Study design and setting: This hospital-based observational study was carried out in the Department of Ophthalmology, Government Medical College, Rajanna Sircilla, Telangana, India, over a six-month period from July 2025 to December 2025. The study was designed to describe the clinical pattern of dry eye disease and the frequency of selected risk factors among adult outpatients. Study population and sample size: The study included 100 adult participants attending the ophthalmology outpatient department during the study period. Consecutive eligible patients were enrolled until the required sample size was achieved. Adults aged 21 years and above who were willing to participate and provide informed consent were considered for inclusion. Patients with acute ocular trauma, active ocular infection requiring emergency care, recent ocular surgery, severe eyelid abnormalities preventing tear film assessment, or inability to cooperate with examination were excluded. Data collection: After obtaining informed written consent, each participant underwent evaluation using a structured proforma. Information regarding age, sex, place of residence, ocular symptoms, digital screen exposure, contact lens use, exposure to air conditioning or dusty environments, and history of systemic comorbidity such as diabetes mellitus or hypertension was recorded. Symptoms specifically assessed included ocular dryness, burning sensation, foreign body sensation, itching, and blurred vision. A detailed anterior segment examination was performed in all cases. Assessment of dry eye disease: Dry eye disease was assessed using a combination of symptom review and routine clinical tests consistent with commonly used diagnostic approaches in outpatient ophthalmology practice [1,3,6]. Schirmer’s test without anesthesia was used to estimate aqueous tear secretion, and a value below 10 mm was considered abnormal. Tear film break-up time (TBUT) was measured after fluorescein instillation; a value below 10 seconds was taken to indicate tear film instability. Corneal fluorescein staining was examined under cobalt blue illumination to identify ocular surface epithelial damage. Participants with compatible symptoms and supportive objective findings were categorized as having dry eye disease. Severity was classified clinically into mild, moderate, and severe categories on the basis of the composite symptom burden and examination findings recorded during evaluation. Study variables: The main outcome variable was the presence of dry eye disease. Secondary descriptive variables included severity category, symptom distribution, abnormal Schirmer’s test, reduced TBUT, positive fluorescein staining, and frequency of selected putative risk factors. Statistical analysis: Data were entered into a spreadsheet and analyzed using descriptive statistical methods. Continuous variables were summarized as mean and standard deviation, and categorical variables were presented as frequency and percentage. Findings were tabulated to depict demographic profile, disease pattern, symptom spectrum, clinical test abnormalities, and distribution of the evaluated risk factors. Ethical considerations: Institutional ethical clearance was obtained before the commencement of the study. Written informed consent was obtained from all participants, and confidentiality of patient information was maintained throughout the study.

A total of 100 adults attending the ophthalmology outpatient department were included in the study. The largest proportion of participants belonged to the 31–40 years age group [32.0%], followed by 41–50 years [26.0%], 21–30 years [22.0%], and more than 50 years [20.0%]. Females constituted 56.0% of the study population, while 63.0% of participants were from urban areas. The mean age of the study participants was 39.8 ± 11.2 years, indicating that the study population was predominantly composed of middle-aged adults with a slight female preponderance [Table 1].

Table 1. Demographic characteristics of the study participants [N = 100]

Mean age of the study participants: 39.8 ± 11.2 years.

Dry eye disease was identified in 34 out of 100 participants, giving an overall prevalence of 34.0% in the study population. Among the affected participants, mild dry eye disease was the most frequent presentation, accounting for 52.9% of cases, followed by moderate disease in 32.4% and severe disease in 14.7%. These findings indicate that most diagnosed cases in the present study were of lower clinical severity at the time of presentation [Table 2].

Table 2. Prevalence and severity of dry eye disease among study participants [N = 100]

With regard to symptom profile among participants with dry eye disease, ocular dryness was the most frequently reported complaint [29.4%], followed by burning sensation [23.5%], foreign body sensation [20.6%], itching [14.7%], and blurred vision [11.8%]. On clinical evaluation, tear film break-up time less than 10 seconds was the most common abnormal finding in the overall study population [28.0%], followed by Schirmer’s test less than 10 mm [21.0%] and positive corneal fluorescein staining [15.0%]. These observations suggest that tear film instability was the most prominent clinical abnormality in the present cohort [Table 3].

Table 3. Symptoms and clinical test findings among study participants [N = 100]

*Symptoms are shown among participants diagnosed with dry eye disease [n = 34].

Among the evaluated risk factors, screen exposure of more than 4 hours per day was the most common, present in 42.0% of participants. Exposure to air conditioning or dusty environments was recorded in 36.0%, while diabetes and/or hypertension were present in 18.0% and contact lens use in 12.0% of participants. These findings indicate that prolonged digital screen use and environmental exposure were the most frequent risk-related factors documented in this outpatient population [Table 4].

Table 4. Distribution of risk factors associated with dry eye disease [N = 100]

Overall, the present study showed that dry eye disease affected nearly one-third of adults attending the ophthalmology outpatient department. Most cases were mild to moderate in severity. Ocular dryness was the leading symptom, reduced TBUT was the most frequent abnormal clinical test, and prolonged screen exposure emerged as the most commonly recorded risk factor.

The present study found that dry eye disease was identified in 34% of adults attending the ophthalmology outpatient department, indicating a substantial ocular surface burden in routine clinical practice. This proportion fits within the broad prevalence range described in the TFOS DEWS II epidemiology report and is comparable to several hospital-based and regional studies that have documented considerable variability across populations, diagnostic criteria, and care settings [4,7,8,11,12]. The observed burden supports the view that DED is a frequent outpatient problem that warrants structured assessment in general ophthalmology services.

A notable feature of the present series was the predominance of mild and moderate disease over severe disease. This pattern is clinically relevant because it suggests that many patients present at a stage when symptom recognition, environmental counseling, and first-line therapy can still be instituted before marked ocular surface compromise develops [14]. The symptom profile was also typical of DED, with ocular dryness, burning sensation, and foreign body sensation forming the dominant complaints. These findings are consistent with the established symptom complex described in contemporary dry eye literature and reflect the interplay of tear film instability, ocular surface irritation, and inflammatory change [1-3,5].

Among the objective tests, reduced TBUT was the most frequent abnormality, followed by reduced Schirmer’s values and positive corneal fluorescein staining. This finding points toward tear film instability as a prominent clinical pattern in the studied outpatient population. TFOS DEWS II emphasizes that DED commonly involves both evaporative and aqueous-deficient mechanisms, often in overlapping form, and that TBUT remains a practical marker of tear film instability in day-to-day practice [2,3,6]. The relatively higher frequency of reduced TBUT than abnormal Schirmer values in the present study also agrees with the concept that tear film instability often becomes evident before more advanced surface damage is established [3,6].

The distribution of evaluated exposures in this study highlights the importance of prolonged screen use and adverse environmental conditions. Screen exposure exceeding 4 hours per day was the commonest factor recorded, followed by exposure to air conditioning or dusty environments. This pattern mirrors earlier studies showing that digital device use, reduced blink rate, and visually demanding near work contribute importantly to dry eye symptoms and signs [9,10,12]. Contact lens use and systemic comorbidity were less frequent but remained clinically relevant. Previous epidemiologic work has similarly identified female sex, environmental stressors, systemic disease, and occupational or lifestyle factors as contributors to DED burden [4,7,11-13].

The demographic profile of the present cohort showed a higher proportion of females and a concentration of participants in the 31-40 year age group. Although inferential association testing was not performed in this descriptive study, these observations are consistent with broader epidemiologic trends reported in the literature [4,7,8,13]. Overall, the study underscores the value of systematic symptom inquiry and basic tear film testing in adults attending ophthalmology outpatient services. In tertiary care settings serving populations with changing digital habits and environmental exposure, screening linked with patient education on screen ergonomics, environmental modification, and timely treatment can strengthen early diagnosis and improve ocular comfort and functional visual well-being [5,14].

Limitations

This study was conducted in a single tertiary ophthalmology outpatient setting with a sample size of 100, which limits wider generalizability. The descriptive cross-sectional design captures exposure and disease status at one time point and does not establish temporal sequence. Symptom assessment depended partly on self-report, and advanced investigations such as tear osmolarity, meibography, or standardized symptom scoring were not incorporated.

Dry eye disease constituted an important clinical problem among adults attending the ophthalmology outpatient department in this study, affecting 34% of the evaluated participants. Most cases were mild or moderate, and the overall clinical picture was dominated by ocular dryness, reduced tear film break-up time, and a meaningful burden of prolonged screen exposure and environmental stress. These findings reinforce the practical value of routine symptom review and basic tear film assessment in outpatient ophthalmology practice. Early identification of symptomatic individuals, coupled with counseling on screen hygiene, avoidance of adverse environmental exposure, and appropriate stepwise treatment, can improve patient comfort, support ocular surface health, and reduce progression to more troublesome disease.

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