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Original Investigation
July 2, 2020

Association of the Indoor Environment With Dry Eye Metrics

Author Affiliations
  • 1University of Central Florida College of Medicine, Orlando
  • 2Miller School of Medicine, University of Miami, Miami, Florida
  • 3Department of Ophthalmology, Miami Veterans Affairs (VA) Medical Center, Miami, Florida
  • 4Bascom Palmer Eye Institute, University of Miami, Miami, Florida
  • 5Environmental Health Division, University of Miami, Miami, Florida
  • 6Department of Ophthalmology, University of Maryland, Baltimore, Maryland
JAMA Ophthalmol. Published online July 2, 2020. doi:10.1001/jamaophthalmol.2020.2237
Key Points

Question  Are there associations between the indoor environment, specifically temperature, humidity, and air pollutants, and the symptoms and signs of dry eye?

Findings  In this cross-sectional study of 97 US veterans, humidity was positively associated with dry eye metrics. In multivariate models, concentration of particulate air pollutants was associated with dry eye symptoms and signs.

Meaning  These findings suggest that indoor environmental manipulations, such as regulating humidity and reducing airborne particulate matter, may be a therapeutic target in some individuals with dry eye.


Importance  The ocular surface is continuously exposed to the environment. Although studies have focused on associations between outdoor environmental conditions and dry eye, information on associations between the indoor environment and dry eye is lacking.

Objective  To determine associations between the indoor environment and dry eye.

Design, Setting, and Participants  This prospective cross-sectional study sample of 97 veterans with a wide range of dry eye metrics was recruited from the Miami Veterans Affairs Healthcare eye clinic from October 19, 2017, to August 30, 2018. Dry eye metrics were first evaluated in the clinic, followed by indoor home environmental metrics within 1 week using a handheld particle counter. Data were analyzed from October 19, 2017, to August 30, 2018.

Main Outcomes and Measures  Symptoms of dry eye were assessed with standardized questionnaires. Dry eye signs were assessed via standard examination. Indoor environmental metrics included temperature, humidity, and particulate matter mass and count.

Results  Of the 97 participants included in the analysis, 81 (84%) were men, with a mean (SD) age of 58.2 (11.9) years. Dry eye symptoms were in the moderate range with a mean (SD) Ocular Surface Disease Index (OSDI) score of 31.2 (23.6). Humidity was associated with worse symptoms and signs, including OSDI score (r = 0.30 [95% CI, 0.07-0.49]; P = .01), inflammation (r = 0.32 [95% CI, 0.10-0.51]; P = .01), Schirmer score (r = −0.25 [95% CI, −0.45 to 0.02]; P = .03), eyelid vascularity (r = 0.27 [95% CI, 0.05-0.47]; P = .02), and meibomian gland dropout (r = 0.27 [95% CI, 0.05-0.47]; P = .02). In multivariate analyses, particulate matter of 2.5 μm or less (PM2.5) was associated with dry eye metrics when adjusted for demographic characteristics, comorbidities, medications, and interaction variables. For example, a 1-unit increase in instrumented PM2.5 level was associated with a 1.59 increase in the OSDI score (95% CI, 0.58-2.59; P = .002), a 0.39 reduction in Schirmer score (95% CI, −0.75 to −0.03; P = .04), a 0.07 increase in meibomian gland dropout (95% CI, 0.01-0.13; P = .02), and a 0.06 increase in inflammation (95% CI, 0.02-0.11; P = .009).

Conclusions and Relevance  When adjusting for humidity, this study found that increased particulate matter exposure was associated with worse dry eye metrics. Humidity was positively associated with dry eye metrics, potentially because higher humidity increases microbial growth and particulate matter size and mass.

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