{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T19:54:41Z","timestamp":1781121281057,"version":"3.54.1"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim of the current study was to investigate the relationship between nasopharyngeal carcinoma (NPC) and dry eye disease (DED) using the National Health Insurance Research Database (NHIRD) of Taiwan. A retrospective cohort study was conducted, and patients with an NPC diagnosis were included. Next, one NPC patient was matched to four non-NPC participants via demographic data and systemic comorbidities. In total, 4184 and 16,736 participants were enrolled in the NPC and non-NPC groups, respectively. The primary outcome was the development of DED one year after the diagnosis of NPC. Cox proportional hazard regression was applied to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of DED. In this study, 717 and 2225 DED cases were found in the NPC and non-NPC groups, respectively, and the NPC group showed a significantly higher incidence of DED development compared to the non-NPC group (aHR: 1.45, 95% CI: 1.33\u20131.58, p &lt; 0.0001) in the multivariable analysis. The other covariates that were positively correlated with DED development included age over 40 years, an education level higher than senior high school, hypertension, DM, allergic pulmonary diseases, allergic otolaryngologic diseases, and allergic dermatological diseases (all p &lt; 0.05). In conclusion, the presence of NPC is an independent risk factor for subsequent DED.<\/jats:p>","DOI":"10.3390\/ijerph20010387","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T04:42:47Z","timestamp":1672116167000},"page":"387","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nasopharyngeal Carcinoma and Its Effect on Dry Eye Disease: A Nationwide Cohort Study"],"prefix":"10.3390","volume":"20","author":[{"given":"Ching-Tai","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-7927","authenticated-orcid":false,"given":"Shun-Fa","family":"Yang","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Chun","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan"},{"name":"Department of Optometry, Central Taiwan University of Science and Technology, Taichung 406, Taiwan"},{"name":"Department of Optometry, Yuan Pei University, Hsinchu 300, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-0488","authenticated-orcid":false,"given":"Chia-Yi","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Ophthalmology, Nobel Eye Institute, Taipei 115, Taiwan"},{"name":"Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 41265, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Yang","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan"},{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Optometry, Chung Shan Medical University, Taichung 402, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1016\/S0140-6736(15)00055-0","article-title":"Nasopharyngeal carcinoma","volume":"387","author":"Chua","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1158\/1055-9965.EPI-20-1702","article-title":"The evolving epidemiology of nasopharyngeal carcinoma","volume":"30","author":"Chang","year":"2021","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S0140-6736(19)30956-0","article-title":"Nasopharyngeal carcinoma","volume":"394","author":"Chen","year":"2019","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1177\/014556130608500313","article-title":"Review of nasopharyngeal carcinoma","volume":"85","author":"Jeyakumar","year":"2006","journal-title":"Ear Nose Throat J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101890","DOI":"10.1016\/j.ctrv.2019.101890","article-title":"Management of locally recurrent nasopharyngeal carcinoma","volume":"79","author":"Lee","year":"2019","journal-title":"Cancer Treat. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/CAD.0b013e328337160e","article-title":"Treatment approaches to nasopharyngeal carcinoma: A review","volume":"21","author":"Caponigro","year":"2010","journal-title":"Anticancer Drugs"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e30516","DOI":"10.1097\/MD.0000000000030516","article-title":"The influence of marital status on survival in patients with nasopharyngeal carcinoma: A surveillance, epidemiology, and end results database analysis","volume":"101","author":"Yu","year":"2022","journal-title":"Medicine"},{"key":"ref_8","first-page":"3687","article-title":"Nasopharyngeal carcinoma: A review of current updates","volume":"15","author":"Wu","year":"2018","journal-title":"Exp. Ther. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"10732748211050587","DOI":"10.1177\/10732748211050587","article-title":"Epidemiological profile and clinicopathological, therapeutic, and prognostic characteristics of nasopharyngeal carcinoma in northern morocco","volume":"28","author":"Reffai","year":"2021","journal-title":"Cancer Control"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1002\/lary.24435","article-title":"Association of rhinosinusitis with nasopharyngeal carcinoma: A population-based study","volume":"124","author":"Hung","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/lary.27303","article-title":"Irradiated ears in nasopharyngeal carcinoma survivors: A review","volume":"129","author":"Young","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/01.mlg.0000248738.55387.44","article-title":"Early swallowing problems in a cohort of patients with nasopharyngeal carcinoma: Symptomatology and videofluoroscopic findings","volume":"117","author":"Ku","year":"2007","journal-title":"Laryngoscope"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"417","DOI":"10.2500\/ajra.2009.23.3336","article-title":"Central nervous system infection in patients with postirradiated nasopharyngeal carcinoma: A case-controlled study","volume":"23","author":"Liang","year":"2009","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1038\/sj.eye.6701358","article-title":"Nasopharyngeal carcinoma with orbital invasion","volume":"18","author":"Hsu","year":"2004","journal-title":"Eye"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/01676830.2017.1279658","article-title":"Ophthalmic involvement in nasopharyngeal carcinoma","volume":"36","author":"Wong","year":"2017","journal-title":"Orbit"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3857\/roj.2020.00213","article-title":"Late side effects of radiation treatment for head and neck cancer","volume":"38","author":"Brook","year":"2020","journal-title":"Radiat. Oncol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1056\/NEJMra1407936","article-title":"Dry eye","volume":"378","author":"Clayton","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Tsubota, K., Pflugfelder, S.C., Liu, Z., Baudouin, C., Kim, H.M., Messmer, E.M., Kruse, F., Liang, L., Carreno-Galeano, J.T., and Rolando, M. (2020). Defining dry eye from a clinical perspective. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21239271"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/IOP.0b013e318171a629","article-title":"Nasopharyngeal carcinoma with orbital involvement","volume":"24","author":"Lee","year":"2008","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/IOP.0000000000000714","article-title":"Unilateral alacrima as a presenting symptom of nasopharyngeal carcinoma","volume":"33","author":"Ko","year":"2017","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_21","first-page":"e13735","article-title":"Corticosteroid therapy in optic neuropathy secondary to nasopharyngeal carcinoma","volume":"13","author":"Wahab","year":"2021","journal-title":"Cureus"},{"key":"ref_22","first-page":"92","article-title":"Quantitative assessment of the association between interleukin-10 promoter gene polymorphisms and nasopharyngeal carcinoma susceptibility","volume":"107","author":"Huang","year":"2016","journal-title":"Minerva Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1177\/0194599816629436","article-title":"Sinonasal tract inflammation as a precursor to nasopharyngeal carcinoma: A systematic review and meta-analysis","volume":"154","author":"Riley","year":"2016","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/ICU.0000000000000569","article-title":"Advances in dry eye disease treatment","volume":"30","author":"Henderson","year":"2019","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1007\/s00417-012-1938-3","article-title":"Evaluation of dry eye signs and symptoms in patients with systemic sclerosis","volume":"250","author":"De","year":"2012","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.survophthal.2019.10.004","article-title":"Primary sj\u00f6gren\u2019s syndrome and the eye","volume":"65","author":"Bjordal","year":"2020","journal-title":"Surv. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lee, C.Y., Chen, H.C., Sun, C.C., Lin, H.Y., Lu, K.H., Huang, J.Y., Yeh, C.B., and Yang, S.F. (2019). Gout as a risk factor for dry eye disease: A population-based cohort study. J. Clin. Med., 8.","DOI":"10.3390\/jcm8010062"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lee, C.Y., Yang, K.L., Sun, C.C., Huang, J.Y., Chen, H.C., Chen, H.C., and Yang, S.F. (2020). The development of dry eye disease after surgery-indicated chronic rhinosinusitis: A population-based cohort study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17113829"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1002\/lary.28254","article-title":"Risk of ocular complications following radiation therapy in patients with nasopharyngeal carcinoma","volume":"130","author":"Lin","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/NHH.0000000000000652","article-title":"Dry eye disease: Prevalence, assessment, and management","volume":"36","author":"Rouen","year":"2018","journal-title":"Home Healthc. Now"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.oraloncology.2014.02.006","article-title":"Etiological factors of nasopharyngeal carcinoma","volume":"50","author":"Tsao","year":"2014","journal-title":"Oral Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1111\/aos.14937","article-title":"The prevalence of dry eye in a very old population","volume":"100","author":"Bikbov","year":"2022","journal-title":"Acta Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.15537\/smj.2016.12.15623","article-title":"Dry eye disease in patients with metabolic syndrome","volume":"37","author":"Cakir","year":"2016","journal-title":"Saudi Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1080\/09273948.2020.1841804","article-title":"Allergy and dry eye disease","volume":"29","author":"Leonardi","year":"2021","journal-title":"Ocul. Immunol. Inflamm."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/387\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:52:01Z","timestamp":1760147521000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,26]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010387"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010387","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,26]]}}}