Making Adjustments to Home Environment May Ease Dry Eye Disease Symptoms

A recent study examined how indoor environmental conditions can affect dry eye disease symptoms and assessed whether home interventions can improve ocular health. The results were presented at the American Academy of Ophthalmology meeting.

In this exclusive MedPage Today video, Anat Galor, MD, from the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, discusses the background and results of the study, as well as steps patients can take to improve their symptoms.

Following is a transcript of her remarks:

As a reference, dry eye is an umbrella term. It includes different symptoms and signs that are driven by different underlying pathophysiologies. And just broadly, we split the world into two categories, nociceptive and neuropathic. So nociceptive means anything in your environment or on the surface of the eye that may trigger nerves to react.

And so one big component that we often miss is that your environment matters. So our ocular surface is there to constantly sense the environment and respond. So things like humidity, temperature, air pollution — those entities all affect the nerves that sense on the ocular surface. And we oftentimes don’t think about it because it’s much more challenging to measure environmental contributors. But if you talk to patients, they will tell you that, OK, certain days are really bad, certain seasons are really bad — suggesting that there are environmental contributors to their symptoms and signs that get them categorized as dry eye.

So with that in mind, most people have looked at outdoor exposures because there are monitoring stations that can tell you the pollen count and the air pollution outdoors. Less information is available on the indoor environment, even though we spend 90% of our life indoors. It changes for different people.

So in Miami, we have this subtropical climate. It’s very warm, lots of mold. And so our hypothesis was that the indoor environment may impact dry eye symptoms and signs. But the bigger question is what to do about it. So the question was, well, if you find a problem and you improve it, do things get better?

So this was an NIH-funded study where we went into patients’ homes and we profiled their exposures. We looked for temperature, humidity, inorganic/organic air pollution, and then we told people like, “Hey, look at this, you have mold, you have high levels of bacteria, your humidity is through the roof, but your temperature is just right.”

So there are environmental protection metrics that they tell you what’s good and what’s not good. With temperature and humidity, there are “Goldilocks” zones — you don’t want to be too low or too high. With things like air pollution and mold, the lower the better. Those are the general concepts.

And so then we followed up 6 months later and we asked people, “Hey, did you do any of the things that we recommended, and how do your eyes feel?” And not surprisingly, not everyone did what we said. People did different things because for each person, we came up with personalized recommendations based on what we found. And so these are all the limitations.

However, we found that certain environmental metrics that improved theoretically the environment in the home had a beneficial effect on symptoms. And as dry eye is not complex enough, we’re just adding another level. Maybe consider your home and outdoor environment and even the suggestion that it may not all be anti-inflammatory eyedrops. Maybe improving your environment will help improve your symptoms and signs.

And there are lots of different things. The first thing is understanding your environment. I mean, do you know if you have mold in your house? Do you know what your air particulate level is? So we need to get better ways for people to have an idea of what they’re exposed to. And then we need to give them easy fixes. Like in Miami, putting a UV filter in the air conditioning unit, that’s one way to reduce the environmental organic bacteria and fungi. Looking at air purifiers, looking to changing your air filters. Things that I think people don’t often think about when it comes to a disease state, but probably should.