Impact of Air Conditioning on Dry Eye Symptoms: A Cross-Sectional Study Using the Ocular Surface Disease Index

Abstract

Background:

Dry eye disease (DED) is a prevalent, multifactorial ocular condition that significantly impacts quality of life. Environmental factors, particularly air conditioning (AC), have been implicated in exacerbating dry eye symptoms. AC systems alter indoor air quality by reducing humidity, increasing airflow, and introducing pollutants—all of which may negatively influence the ocular surface. Despite widespread AC use, the extent of its impact on DED symptoms remains underexplored in controlled population settings.

Aim:

To assess the impact of air conditioning exposure on Ocular Surface Disease Index (OSDI) scores and tear production among individuals residing or working in air-conditioned versus non-air-conditioned environments.

Methods:

This cross-sectional observational study included 100 participants aged 18 years and above, categorized based on AC exposure duration (0, 1–10, 11–15, >15 hours/day) and environment (indoor vs. outdoor). The OSDI questionnaire was administered to evaluate dry eye symptom severity. Tear production (in mm) and temperature set points were recorded. Statistical analyses included chi-square tests and independent sample t-tests to assess associations and differences between groups. A p-value of <0.01 was considered statistically significant.

Results:

Participants with longer AC exposure had significantly higher OSDI scores, indicating more severe symptoms. Indoor participants (72%) reported a higher mean OSDI score (30.2 ± 17.3) than outdoor participants (17.5 ± 14.9; p < 0.001). Tear production was lower in indoor environments: OD (11.2 ± 4.2 mm vs. 15.3 ± 4.1 mm, p < 0.001) and OS (11.4 ± 4.6 mm vs. 16.0 ± 4.1 mm, p < 0.001). Temperature set points were significantly lower indoors. A strong association was observed between AC duration and both environmental setting and age group.

Conclusion:

Prolonged exposure to air conditioning is associated with increased severity of dry eye symptoms and reduced tear production. These findings highlight the adverse effects of AC-induced environmental changes—such as low humidity and increased airflow—on the ocular surface. Given the rising reliance on AC systems, especially in urban and occupational

settings, environmental assessment should be integrated into dry eye evaluations. Preventive strategies like humidity control and limiting AC exposure may help mitigate symptom severity.