PURPOSE: To determine the countrywide prevalence of dry eye disease (DED) at the population level in Spain, and associated risks. METHODS: This was a cross-sectional study based on a telephone survey conducted in 2022. Participants from the general population were selected by sex, age, region, and population of residence to ensure the representativeness of the Spanish population. Participants responded to 42 questions on sociodemographic characteristics, clinical diagnosis of DED, DED-related symptoms, comorbidities, prior eye surgery, current intake of specific drugs, use of contact lenses or artificial tears, and the use of digital screens. The criteria from the Women's Health Study (WHS) and the Beijing Eye Study (BES) were used to determine DED. RESULTS: A total of 3019 interviews were conducted. The prevalence of DED according to WHS criteria was 16.6 % (10.9 % men versus 21.3 % women, p <
0.001)
12.3 % of respondents reported having a clinical diagnosis of DED. The age group 18-29 years presented a high frequency of symptoms. According to the BES criteria, the prevalence of DED was 22.5 % (20.2 % of men, 24.6 % of women, p = 0.005). Diabetes, glaucoma, and blepharitis, the intake of antidepressants/anxiolytics, blood pressure drugs, and sleeping pills, and prior eye surgery were significant risk factors (p <
0.0001). The use of digital screens for <
6 h per day was significantly associated with DED. CONCLUSIONS: Prevalence of DED in Spain was high among young adults, who presented a combination of high frequency of symptoms and low rates of clinical diagnosis. Increased awareness should be promoted in this population group.