Dry eye disease (DED) is a prevalent and often underdiagnosed condition characterized by insufficient tear production or poor tear quality, leading to ocular discomfort, irritation, and potential vision disturbances. It significantly impacts the quality of life, causing symptoms such as dryness, burning, and blurred vision, which can interfere with daily activities like reading, driving, and using digital devices. Despite its widespread occurrence, especially among older adults and individuals with prolonged screen exposure, public awareness and understanding of dry eye disease remain inadequate, particularly in rural and semi-urban regions.^1-4

Kangra District, located in Himachal Pradesh, presents a unique context for studying dry eye disease due to its distinct climatic conditions and predominantly rural population. Factors such as low humidity, high altitude, and exposure to environmental pollutants may increase the risk of developing dry eye symptoms. However, the level of awareness about this condition and its risk factors, symptoms, and management options remains largely unexplored among the general population in this region. Limited knowledge and misconceptions about dry eye disease can lead to delayed diagnosis, inappropriate management, and an increased burden of complications.

This study aims to assess the awareness and knowledge of dry eye disease among the general public in Kangra District, Himachal Pradesh. By identifying gaps in understanding and common misconceptions, the research seeks to inform public health strategies that can enhance early detection, promote preventive measures, and improve the overall management of dry eye disease in this region. Ultimately, this study aims to contribute to better eye health outcomes and a higher quality of life for the people of Kangra.

Objectives of the Study

The primary objective of this study is to gauge awareness and knowledge about dry eye disease among the general public in Kangra District, Himachal Pradesh. By identifying gaps in knowledge, the study seeks to inform public health initiatives that can improve the management and prevention of dry eye disease in the 

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: Kangra District, Himachal Pradesh

• Study Duration: January 2024 to May 2024

• Study Population: The target population includes all adults aged 18 and above who have been residents of Kangra District, Himachal Pradesh, for a minimum of 12 months.

• Sample Size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding dry eye disease, a precise 5% absolute error margin, and a conservative 5% non-response rate.

• Study Tool: A Google form questionnaire consisting of questions regarding socio-demography and knowledge about dry eye disease was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulties in understanding by the respondents.

   

Description of Tool:

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background, including age, gender, marital status, religion, employment, education, and more.

• Questionnaire: The questionnaire contains 20 structured knowledge-related questions regarding dry eye disease. One mark was given for each correct answer and zero for incorrect answers. The maximum score was 20, and the minimum score was zero. Scoring was done on the basis of marks as follows:

• Validity of Tool: The tool was validated by experts in the field.

• Data Collection: Data was collected under the guidance of supervisors. The Google form questionnaire was circulated among the residents of Kangra District, Himachal Pradesh, for responses using online modes such as e-mail and social media platforms like WhatsApp groups, Facebook, Instagram, and LinkedIn until 400 responses were collected.

• Data Analysis: Data was collected and entered in a Microsoft Excel spreadsheet, cleaned for errors, and analyzed with Epi Info V7 Software using appropriate statistical tests in terms of frequencies and percentages.

• Ethical Considerations: Participants' confidentiality and anonymity were maintained throughout the study.

• 80% (16-20) = Very Good

• 60-79% (12-15) = Good

• 41-59% (8-11) = Fair

• <40% (<8) = Poor

The socio-demographic characteristics of the study participants, as outlined in Table 1, provide a comprehensive view of the population involved in this study. The age distribution shows that the majority of participants were between 18 and 30 years old (30.3%), followed by those aged 31 to 40 (25.5%). Participants in the 41 to 50 age group comprised 22.0% of the sample, while those over 50 accounted for 22.3%. The gender distribution was relatively balanced, with females slightly outnumbering males at 52.0% compared to 48.0%. In terms of marital status, the majority were married (56.8%), while 40.0% were single, and a small percentage (3.3%) fell into other categories. The predominant religion among participants was Hinduism (83.3%), followed by smaller percentages of Muslims (6.8%), Sikhs (7.8%), and others (2.3%). Employment status revealed that nearly half of the participants were employed (49.5%), with 26.5% unemployed and 24.0% being students. Education levels varied, with 34.3% having a graduate degree, 27.3% completing high school, 24.8% holding postgraduate or higher qualifications, and 13.8% having education below high school level.

Table 1: Socio-Demographic Characteristics of Study Participants (N=400)

Table 2 highlights the participants' knowledge regarding the symptoms of dry eye disease. A significant portion of the population (78.8%) had heard of dry eye disease, indicating a general awareness of the condition. Regarding specific symptoms, 72.3% of respondents knew that dry eye disease could cause eye irritation, while 69.0% were aware of the association with eye redness. Knowledge about blurry vision as a symptom was reported by 66.3% of participants. However, only between 33.8% recognized sensitivity to light as a related symptom, indicating a lower awareness of this less commonly known symptom. These findings suggest a moderate to high level of awareness regarding the common symptoms of dry eye disease among the study population, but they also reveal a gap in knowledge about sensitivity to light.

Table 2: Knowledge Regarding Symptoms of Dry Eye Disease (N=400)

Table 3 presents the participants' knowledge regarding the causes and risk factors of dry eye disease. Aging was identified as a risk factor by 61.0% of respondents, while 59.3% were aware that prolonged screen use could contribute to the condition. Additionally, 57.3% of participants recognized that certain medications might lead to dry eye disease, and 55.3% acknowledged environmental factors like wind and smoke as potential causes. Furthermore, 53.8% were aware that wearing contact lenses for long periods could result in dry eyes. These results indicate a decent level of understanding of the various factors that can contribute to the development of dry eye disease.

Table 3: Knowledge Regarding Causes and Risk Factors of Dry Eye Disease (N=400)

In terms of prevention, as shown in Table 4, just over half of the participants (53.5%) knew that taking breaks during screen use could help prevent dry eyes. Knowledge about the use of artificial tears to prevent symptoms was between 65.5%, indicating a moderate awareness of this preventive strategy. Additionally, 50.5% recognized that wearing sunglasses outdoors could protect against dry eyes. However, slightly fewer participants were aware of the importance of staying hydrated (48.3%) and maintaining a humid environment (45.0%) as preventive measures. These findings suggest that while there is some awareness of preventive strategies, there is still room for improvement, particularly in promoting lifestyle habits that can mitigate the risk of dry eye disease.

Table 4: Knowledge Regarding Prevention of Dry Eye Disease (N=400)

Table 5 provides insight into the participants' knowledge regarding the treatment and management of dry eye disease. 54.0% of respondents knew that artificial tears could help manage symptoms, reflecting a moderate level of awareness about this common treatment option. However, only 45.3% recognized the role of lifestyle changes in managing the condition. Knowledge about warm compresses as a treatment option was even lower, with 42.8% awareness. Additionally, only 37.3% of participants were aware that surgical intervention might be necessary for severe cases, highlighting a significant gap in understanding more advanced treatment options. Notably, 19.8% of participants knew that surgical intervention might be required in severe cases, emphasizing a critical area where public knowledge needs to be improved.

Table 5: Knowledge Regarding Treatment and Management of Dry Eye Disease (N=400)

Finally, Table 6 categorizes the overall knowledge scores of the participants. About a quarter of the respondents (25.5%) demonstrated a "Very Good" level of knowledge, scoring between 16 and 20 on the questionnaire. The largest proportion (29.8%) fell into the "Good" category with scores between 12 and 15, while 26.8% had a "Fair" level of knowledge, scoring between 8 and 11. However, 18.0% of participants were categorized as having "Poor" knowledge, with scores below 8. These findings emphasize the variability in knowledge levels among the population and suggest a need for targeted educational interventions to enhance awareness and understanding of dry eye disease across different segments of the community.

Table 6: Overall, Knowledge Score Categories for Dry Eye Disease (N=400)

The findings of this study provide valuable insights into the awareness and knowledge of dry eye disease (DED) among the general population of Kangra District, Himachal Pradesh. The results reveal that while a significant portion of the population has some awareness of DED, substantial gaps in knowledge persist, particularly regarding the less commonly known symptoms, preventive measures, and advanced treatment options. These gaps highlight the need for targeted educational interventions to improve public understanding of this increasingly prevalent condition.

The study indicates that a considerable proportion of participants (78.8%) had heard of dry eye disease, suggesting a baseline level of awareness about the condition within the community. However, knowledge about specific symptoms varied. While 72.3% of respondents recognized eye irritation as a symptom, and 69.0% were aware that redness could be associated with DED, fewer participants were familiar with symptoms such as blurry vision (66.3%) and sensitivity to light (33.8%). This variability in symptom recognition points to a partial understanding of DED among the population, where more common symptoms are better recognized than those less frequently discussed in public health messages. The relatively low awareness of sensitivity to light as a symptom suggests that individuals may not fully understand the spectrum of DED manifestations, potentially leading to delayed diagnosis and treatment.^4-7

When examining knowledge about the causes and risk factors of DED, the results indicate a moderate level of awareness. A majority of participants identified aging (61.0%) and prolonged screen use (59.3%) as contributing factors to dry eye disease. This is consistent with global trends where screen use has become a significant risk factor due to increased digital device usage. However, knowledge about other risk factors, such as certain medications (57.3%), environmental factors like wind and smoke (55.3%), and contact lens use (53.8%), was slightly lower. These findings suggest that while some common causes of DED are well-known, there is a need for more comprehensive education on the full range of risk factors. This is particularly important in a region like Kangra, where environmental factors and lifestyle choices may exacerbate the condition.^7-9

The study reveals that awareness of preventive measures for dry eye disease is present but could be significantly improved. Just over half of the participants (53.5%) knew that taking breaks during screen use could help prevent dry eyes, and 65.5% were aware that using artificial tears could prevent symptoms. However, fewer respondents recognized the importance of wearing sunglasses outdoors (50.5%), staying hydrated (48.3%), and maintaining a humid environment (45.0%) as preventive strategies. These findings suggest that while some preventive measures are known, others, particularly those related to lifestyle and environmental adjustments, are less well understood. Public health initiatives should focus on promoting a holistic approach to eye care, emphasizing not just artificial tears but also the importance of hydration, protective eyewear, and environmental controls in preventing DED.^8-11

The knowledge gap becomes even more pronounced in the area of treatment and management of dry eye disease. While 54.0% of participants were aware that artificial tears could help manage symptoms, fewer were knowledgeable about the role of lifestyle changes (45.3%) and warm compresses (42.8%) in managing the condition. Moreover, only 19.8% of respondents were aware that surgical intervention might be necessary in severe cases. This lack of awareness about advanced treatment options highlights a critical gap in understanding the full spectrum of DED management strategies. It suggests that many individuals may not seek appropriate medical advice or treatment, relying instead on over-the-counter solutions without considering more comprehensive or advanced interventions. This can lead to inadequate management of the disease and a potential worsening of symptoms.^7-11

The variability in knowledge scores, with 25.5% of participants demonstrating a "Very Good" understanding and 18.0% categorized as having "Poor" knowledge, underscores the diverse levels of awareness within the community. This distribution suggests that while some segments of the population are well-informed, a significant portion remains undereducated about dry eye disease. Public health strategies should therefore be tailored to address these knowledge gaps, with targeted educational campaigns that focus on both the common and less commonly recognized aspects of DED.

To improve the management and prevention of dry eye disease in Kangra District, public health initiatives should prioritize comprehensive education on the full range of symptoms, causes, and treatment options. Healthcare providers can play a pivotal role by actively engaging with the community through awareness programs, workshops, and outreach initiatives that emphasize the importance of early diagnosis and holistic management of DED. Additionally, given the environmental and lifestyle factors unique to the region, customized interventions that address these specific risks could be particularly effective.

This study highlights the need for enhanced public health initiatives in Kangra District to address the knowledge gaps related to dry eye disease. By equipping individuals with the knowledge needed to recognize symptoms, understand risk factors, and adopt effective preventive and treatment measures, healthcare providers can significantly improve the management of dry eye disease in the region. Such efforts will not only reduce the burden of this condition but also enhance the overall eye health and quality of life for the people of Kangra.

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