Economic Burden of Dry Eye Disease in India: A Systematic Review and Meta-Analysis

Purpose: To systematically evaluate the economic burden of dry eye disease (DED) in India through comprehensive analysis of prevalence patterns, direct medical costs, productivity impacts, and comparative international assessments. Methods: This systematic review followed PRISMA 2020 guidelines with comprehensive database searches from January 2006 to September 2025. We identified studies reporting DED prevalence, economic outcomes, and quality of life measures in Indian populations. Random-effects meta-analysis employed DerSimonian-Laird methodology with Knapp-Hartung adjustments. Economic data underwent conversion to 2024 USD using purchasing power parity. Results: Analysis of 15 studies encompassing 52,743 participants revealed pooled DED prevalence of 26.8% (95% CI: 18.4-37.2%; I²=96%). Hospital-based studies demonstrated 32.1% prevalence compared to 19.3% in population-based investigations. Geographic variation showed highest prevalence in plains regions at 41.3%, followed by hilly areas at 24.0% and coastal regions at 9.9%. Information technology professionals exhibited 46.3% prevalence. Direct medical costs ranged from ₹2,000-45,000 ($25-540) annually, while productivity losses represented 85-90% of total economic burden. Conclusions: DED imposes substantial economic burden in India with prevalence comparable to global estimates but significantly lower direct costs. Digital device exposure emerges as the primary risk factor among working-age populations. Investment in workplace prevention programs and cost-effective treatments demonstrates favorable economic returns.