Dry eye disease (DED) is a common multifactorial disease of the tears and ocular surface characterized by tear film instability and/or deficiency and ocular inflammation, causing discomfort and visual disturbances [1]. Depending on instruments used, the prevalence of DED ranges from 5% to 50% and is more common in females and those of older age [2,3]. DED often decreases quality of life [[4], [5], [6], [7], [8]] and interferes with activities of daily life, such as reading, watching television, work-related tasks, and quality of sleep [6,9]. In the US alone, the economic burden of DED is estimated to an annual cost of USD 3.84 billion [10]. Symptoms are generally difficult to treat, and there is currently no cure for DED [2,11,12]. It is therefore important to discover modifiable risk factors and interventions that may combat the development of DED.

Sedentary behavior (SB) is a key modifiable lifestyle factor that increases the risk of several negative health outcomes, such as cardiovascular disease and mortality [[13], [14], [15]]. This could partially stem from SB-induced chronic inflammation [16,17], a process which can also disrupt the ocular surface [18,19]. Three past studies assessing the association between SB and DED [[20], [21], [22]] revealed varying results; with a positive association in two studies [20,21], but negative association in one [22]. Ultimately, the link between SB and DED remains unclear.

Thus, this cross-sectional study from the Netherlands seeks to further clarify the link between SB and DED in the general population. Our study is the first to assess this relationship in a European population. There are notable differences in patterns of SB between cultures and cohorts [[23], [24], [25]]. It is, therefore, important to analyze this in a diverse range of populations. We assessed the relationship in several ways. Importantly, we corrected for a large number of medical comorbidities associated with DED. We are also the first to test if physical activity (PA) is an effect modifier of this association, as it has been shown to be with other health outcomes like cardiovascular disease and mortality [15,26].