Environmental Drivers of Dry Eye Disease: A Narrative Review of Pollutants, Climate, and Indoor Exposures with Practice Recommendations

Dry eye disease (DED) is a multifactorial and prevalent condition of the ocular surface that is associated with a wide range of risk factors. In the modern world, environmental conditions and pollution have become increasingly relevant contributors. Recent findings from the Tear Film & Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) highlight the contribution of oxidative stress, inflammatory cytokines, and neurosensory alterations to environmentally associated DED. This narrative, non-systematic review aims to synthesize current evidence on the impact of climate change and exposure to pollutants on the epidemiology, pathophysiology, and management of DED, with a particular emphasis on clinical practice. A targeted search of peer-reviewed literature was conducted in PubMed and Scopus, focusing on previous reviews and original human studies evaluating environmental exposures and DED, and findings were synthesized qualitatively due to heterogeneity in study design and diagnostic criteria. Environmental influences on the ocular surface encompass a wide range of factors, including climate conditions such as temperature, humidity, wind speed, altitude, dew point, ultraviolet radiation, and allergens, as well as exposure to air pollution from gases, particulate matter, volatile organic compounds, and other airborne contaminants. Individuals living in densely populated cities, industrial zones, and dry climates are at increased risk, and emerging challenges such as wildfires and desertification warrant increasing attention due to their rising global impact. Exposure to these agents may induce or exacerbate tear film instability, epithelial damage, immune dysregulation, and ocular surface inflammation. Although most available studies are cross-sectional or observational, and therefore limited in establishing causality, environmental exposures remain a key contributor to DED and can impair occupational performance, exacerbate pre-existing health conditions, and diminish overall quality of life. Comprehensive screening, environmental risk assessment, patient counseling, and personalized management strategies are essential to the prevention and management of DED in the face of accelerating environmental change.