The association between oral contraceptive pill use and the outcomes of dry eye disease: a systematic review and meta-analysis.

CLINICAL RELEVANCE: Understanding the association between oral contraceptive use and dry eye disease may inform clinical assessment and counselling.

BACKGROUND

To determine the association between oral contraceptive use and dry eye disease outcomes.

METHODS

Four databases were searched in November 2025. Outcomes included dry eye disease association, tear break-up time, Schirmer test, Ocular Surface Disease Index, tear osmolarity, and meibomian gland dysfunction. Random-effects meta-analyses were used to pool association estimates for outcomes with more than three studies, otherwise results were summarised narratively. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklists. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

889 publications were identified; twelve observational studies were included. The pooled odds ratio for dry eye disease in oral contraceptive users compared to non-users was 2.05 (95% CI: 0.82, 5.11; n = 1943; five studies; p = 0.12). Oral contraceptive users had shorter tear break-up time (pooled mean difference -1.49 seconds; 95% CI: -2.44, -0.53; n = 325; five studies; p = 0.0023), though this finding was not robust to sensitivity analysis. Non-statistically significant reduced tear production was observed (Schirmer test pooled mean difference -7.71 mm; 95% CI: -15.89, 0.47; n = 325; five studies; p = 0.0647). Single studies observed increased meibomian gland dysfunction risk (odds ratio 2.58; 95% CI: 1.21, 5.52; n = 222; p = 0.01) and higher tear osmolarity (mean difference 3.8 mOsm/L; 95% CI: -2.61, 10.21; n = 49; p = 0.2387) in oral contraceptive users. One study suggested lower median Ocular Surface Disease Index with oral contraceptive use (2.1 vs 5.4), and another suggested higher median values (18.7 vs 8.3). All outcomes had very low certainty of evidence.

CONCLUSION

Oral contraceptive use was not associated with a statistically significant dry eye disease risk or reduced tear production. Reduced tear film stability was observed but was not robust to sensitivity analysis. Certainty of evidence was very low.