{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:26:28Z","timestamp":1791897988181,"version":"4.3.4"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To assess air pollution-induced changes on ocular surface and tear cytokine levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>As a prospective multicenter cohort study, 387 dry eye disease (DED) participants were recruited from five provinces in China and underwent measurements of ocular surface disease index (OSDI), Schirmer\u2019s I test (ST), tear meniscus height (TMH), tear film break-up time (TBUT), corneal fluorescein staining (CFS), meibomian gland (MG) function, and tear cytokines. The associations between ocular surface parameters and exposure to particulate matter (PM), ozone (O<jats:sub>3<\/jats:sub>), nitrogen dioxide (NO<jats:sub>2<\/jats:sub>), and sulfur dioxide (SO<jats:sub>2<\/jats:sub>) for 1 day, 1 week, and 1 month before the examination were analyzed in single- and multi-pollutant models adjusted for confounding factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the multi-pollutant model, the OSDI score was positively correlated with PM with diameter \u22642.5 \u03bcm (PM<jats:sub>2.5<\/jats:sub>), O<jats:sub>3<\/jats:sub>, and SO<jats:sub>2<\/jats:sub> exposure [PM<jats:sub>2.5<\/jats:sub>: \u03b2 (1 week\/month) = 0.229 (95% confidence interval (CI): 0.035\u20130.424)\/0.211 (95% CI: 0.160\u20130.583); O<jats:sub>3<\/jats:sub>: \u03b2 (1 day\/week\/month) = 0.403 (95% CI: 0.229\u20130.523)\/0.471 (95% CI: 0.252\u20130.693)\/0.468 (95% CI: 0.215\u20130.732); SO<jats:sub>2<\/jats:sub>: \u03b2 (1 day\/week) = 0.437 (95% CI: 0.193\u20130.680)\/0.470 (95% CI: 0.040\u20130.901)]. Tear secretion was negatively correlated with O<jats:sub>3<\/jats:sub> and NO<jats:sub>2<\/jats:sub> exposures but positively correlated with PM<jats:sub>2.5<\/jats:sub> levels. Air pollutants were negatively correlated with TBUT and positively related with CFS score. Besides SO<jats:sub>2<\/jats:sub>, all other pollutants were associated with aggravated MG dysfunction (MG expression, secretion, and loss) and tear cytokines increasement, such as PM<jats:sub>2.5<\/jats:sub> and interleukin-8 (IL-8) [\u03b2 (1 day) = 0.016 (95% CI: 0.003\u20130.029)], PM with diameter \u226410 \u03bcm (PM<jats:sub>10<\/jats:sub>) and IL-6 [\u03b2 (1 day) = 0.019 (95% CI: 0.006\u20130.033)], NO<jats:sub>2<\/jats:sub> and IL-6 [\u03b2 (1 month) = 0.045 (95% CI: 0.018\u20130.072)], among others. The effects of air pollutants on DED symptoms\/signs, MG functions and tear cytokines peaked within 1 week, 1 month, and 1 day, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increased PM<jats:sub>2.5<\/jats:sub>, O<jats:sub>3<\/jats:sub>, and SO<jats:sub>2<\/jats:sub> exposures caused ocular discomfort and damage with tear film instability. PM<jats:sub>10<\/jats:sub> exposure led to tear film instability and ocular injury. PM, O<jats:sub>3<\/jats:sub>, and NO<jats:sub>2<\/jats:sub> exposures aggravated MG dysfunction and upregulated tear cytokine levels. Therefore, each air pollutant may influence DED <jats:italic>via<\/jats:italic> different mechanisms within different time windows.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.909330","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T17:00:29Z","timestamp":1657126829000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":49,"title":["Impact of Air Pollution on the Ocular Surface and Tear Cytokine Levels: A Multicenter Prospective Cohort Study"],"prefix":"10.3389","volume":"9","author":[{"given":"Ran","family":"Hao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhou","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinwen","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangyang","family":"Xin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongping","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxuan","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S0140-6736(17)32643-0","article-title":"Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study.","volume":"391","author":"Sinharay","year":"2018","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15102269","article-title":"Association between dry eye disease, air pollution and weather changes in Taiwan.","volume":"15","author":"Zhong","year":"2018","journal-title":"Int J Environ Res Public Health."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132769","article-title":"Air pollution and acute myocardial infarction hospital admission in Alberta, Canada: a three-step procedure case-crossover study.","volume":"10","author":"Wang","year":"2015","journal-title":"PLoS One."},{"key":"B4","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1007\/s00420-015-1102-6","article-title":"Short-term effects of fine particulate air pollution on cardiovascular hospital emergency room visits: a time-series study in Beijing, China.","volume":"89","author":"Su","year":"2016","journal-title":"Int Arch Occup Environ Health."},{"key":"B5","doi-asserted-by":"crossref","DOI":"10.1186\/s12940-016-0129-9","article-title":"Ambient PM2.5 and risk of emergency room visits for myocardial infarction: impact of regional PM2.5 oxidative potential: a case-crossover study.","volume":"15","author":"Weichenthal","year":"2016","journal-title":"Environ Health."},{"key":"B6","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1001\/jama.2012.126","article-title":"Main air pollutants and myocardial infarction: a systematic review and meta-analysis.","volume":"307","author":"Mustafic","year":"2012","journal-title":"JAMA."},{"key":"B7","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1289\/ehp.1408125","article-title":"Long-Term air pollution exposure and blood pressure in the sister study.","volume":"123","author":"Chan","year":"2015","journal-title":"Environ Health Perspect."},{"key":"B8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/HCO.0b013e32833358cd","article-title":"Air pollution and the triggering of cardiac arrhythmias.","volume":"25","author":"Link","year":"2010","journal-title":"Curr Opin Cardiol."},{"key":"B9","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1016\/S0140-6736(16)31679-8","article-title":"Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.","volume":"388","author":"Forouzanfar","year":"2016","journal-title":"Lancet."},{"key":"B10","first-page":"123","article-title":"Effect of environmental air pollution on type 2 diabetes mellitus.","volume":"19","author":"Meo","year":"2015","journal-title":"Eur Rev Med Pharmacol Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1289\/ehp.1307301","article-title":"Long-term exposure to ambient air pollution and incidence of cerebrovascular events: results from 11 European cohorts within the ESCAPE project.","volume":"122","author":"Stafoggia","year":"2014","journal-title":"Environ Health Perspect."},{"key":"B12","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1289\/ehp.10370","article-title":"Air pollution and postneonatal infant mortality in the United States, 1999-2002.","volume":"116","author":"Woodruff","year":"2008","journal-title":"Environ Health Perspect."},{"key":"B13","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/nature15371","article-title":"The contribution of outdoor air pollution sources to premature mortality on a global scale.","volume":"525","author":"Lelieveld","year":"2015","journal-title":"Nature."},{"key":"B14","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1001\/jamaophthalmol.2016.0139","article-title":"Potential importance of ozone in the association between outdoor air pollution and dry eye disease in South Korea.","volume":"134","author":"Hwang","year":"2016","journal-title":"JAMA Ophthalmol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.envpol.2018.11.109","article-title":"Impacts of air pollution on dry eye disease among residents in Hangzhou, China: a case-crossover study.","volume":"246","author":"Mo","year":"2019","journal-title":"Environ Pollut."},{"key":"B16","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report.","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul Surf."},{"key":"B17","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.biopha.2017.10.032","article-title":"A mouse dry eye model induced by topical administration of the air pollutant particulate matter 10.","volume":"96","author":"Li","year":"2017","journal-title":"Biomed Pharmacother."},{"key":"B18","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-36181-x","article-title":"Air pollutant particulate matter 2.5 induces dry eye syndrome in mice.","volume":"8","author":"Tan","year":"2018","journal-title":"Sci Rep."},{"key":"B19","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II Definition and Classification Report.","volume":"15","author":"Craig","year":"2017","journal-title":"Ocul Surf."},{"key":"B20","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/s1542-0124(12)70081-2","article-title":"The definition and classification of dry eye disease: report of the definition and classification subcommittee of the international dry eye workshop (2007).","volume":"5","author":"Lemp","year":"2007","journal-title":"Ocul Surf."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2020.115039","article-title":"Different adverse effects of air pollutants on dry eye disease: ozone, PM2.5, and PM10.","volume":"265","author":"Kim","year":"2020","journal-title":"Environ Pollut."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-10527-y","article-title":"The effects of short-term and long-term air pollution exposure on meibomian gland dysfunction.","volume":"12","author":"Hao","year":"2022","journal-title":"Sci Rep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jes.2020.06.004","article-title":"Characteristics of PM2.5 pollution in Beijing after the improvement of air quality.","volume":"100","author":"Huang","year":"2021","journal-title":"J Environ Sci."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2021.149575","article-title":"Consumption-based PM2.5-related premature mortality in the Beijing-Tianjin-Hebei region.","volume":"800","author":"Li","year":"2021","journal-title":"Sci Total Environ."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182312483","article-title":"Spatial characteristics and regional transmission analysis of PM2.5 pollution in Northeast China, 2016-2020.","volume":"18","author":"Fang","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18105283","article-title":"Impacts of industrial restructuring and technological progress on PM2.5 pollution: evidence from prefecture-level cities in China.","volume":"18","author":"Xu","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B27","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1475-1313.2009.00658.x","article-title":"The effectiveness of questionnaires in the determination of contact lens induced dry eye.","volume":"29","author":"Michel","year":"2009","journal-title":"Ophthalmic Physiol Opt."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/srep37570","article-title":"Evaluation of the effects of conjunctivochalasis excision on tear stability and contrast sensitivity.","volume":"6","author":"Qiu","year":"2016","journal-title":"Sci Rep."},{"key":"B29","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/00003226-199801000-00007","article-title":"Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation.","volume":"17","author":"Pflugfelder","year":"1998","journal-title":"Cornea."},{"key":"B30","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.jtos.2017.05.001","article-title":"TFOS DEWS II Diagnostic Methodology Report.","volume":"15","author":"Wolffsohn","year":"2017","journal-title":"Ocul Surf."},{"key":"B31","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/j.ophtha.2007.06.031","article-title":"Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population.","volume":"115","author":"Arita","year":"2008","journal-title":"Ophthalmology."},{"key":"B32","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/S0161-6420(98)98033-2","article-title":"Meibomian gland dysfunction in patients with Sj\u00f6gren syndrome.","volume":"105","author":"Shimazaki","year":"1998","journal-title":"Ophthalmology."},{"key":"B33","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1167\/iovs.10-6997f","article-title":"The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee.","volume":"52","author":"Tomlinson","year":"2011","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B34","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II Epidemiology Report.","volume":"15","author":"Stapleton","year":"2017","journal-title":"Ocul Surf."},{"key":"B35","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.envint.2014.10.005","article-title":"A review on the human health impact of airborne particulate matter.","volume":"74","author":"Kim","year":"2015","journal-title":"Environ Int."},{"key":"B36","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.envres.2014.02.014","article-title":"Effects of ambient levels of traffic-derived air pollution on the ocular surface: analysis of symptoms, conjunctival goblet cell count and mucin 5AC gene expression.","volume":"131","author":"Torricelli","year":"2014","journal-title":"Environ Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1289\/ehp.10363","article-title":"Ambient levels of air pollution induce goblet-cell hyperplasia in human conjunctival epithelium.","volume":"115","author":"Novaes","year":"2007","journal-title":"Environ Health Perspect."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1097\/ICO.0b013e31820d852a","article-title":"Comparison of mucin levels at the ocular surface of postmenopausal women with and without a history of dry eye.","volume":"30","author":"Gipson","year":"2011","journal-title":"Cornea."},{"key":"B39","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1097\/ACI.0b013e32830e6b04","article-title":"Functions of ocular surface mucins in health and disease.","volume":"8","author":"Mantelli","year":"2008","journal-title":"Curr Opin Allergy Clin Immunol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1164\/ajrccm.160.supplement_1.12","article-title":"Control of mucin transcription by diverse injury-induced signaling pathways.","volume":"160","author":"Basbaum","year":"1999","journal-title":"Am J Respir Crit Care Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1097\/ICO.0b013e31825e845d","article-title":"Correlation between signs and symptoms of ocular surface dysfunction and tear osmolarity with ambient levels of air pollution in a large metropolitan area.","volume":"32","author":"Torricelli","year":"2013","journal-title":"Cornea."},{"key":"B42","doi-asserted-by":"crossref","first-page":"381","DOI":"10.13075\/ijomeh.1896.00442","article-title":"Air pollution and emergency department visits for conjunctivitis: a case-crossover study.","volume":"29","author":"Szyszkowicz","year":"2016","journal-title":"Int J Occup Med Environ Health."},{"key":"B43","doi-asserted-by":"publisher","first-page":"e760","DOI":"10.1016\/S2542-5196(21)00287-4","article-title":"New WHO global air quality guidelines: more pressure on nations to reduce air pollution levels.","volume":"5","author":"Carvalho","year":"2021","journal-title":"Lancet Planet Health."},{"key":"B44","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1289\/ehp.5664","article-title":"Particulate matter, sulfur dioxide, and daily mortality in Chongqing, China.","volume":"111","author":"Venners","year":"2003","journal-title":"Environ Health Perspect."},{"key":"B45","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.puhe.2007.09.017","article-title":"Cardiorespiratory health effects associated with sulphurous volcanic air pollution.","volume":"122","author":"Longo","year":"2008","journal-title":"Public Health."},{"key":"B46","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1136\/oem.2004.015636","article-title":"Ocular morbidity and fuel use: an experience from India.","volume":"62","author":"Saha","year":"2005","journal-title":"Occup Environ Med."},{"key":"B47","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.apm.2014.05.006","article-title":"Tear film dynamics with evaporation, osmolarity and surfactant transport.","volume":"39","author":"Siddique","year":"2015","journal-title":"Appl Math Model."},{"key":"B48","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1097\/ICO.0000000000001867","article-title":"Impact of nanostructured lipid carriers as an artificial tear film in a rabbit evaporative dry eye model.","volume":"38","author":"Niamprem","year":"2019","journal-title":"Cornea."},{"key":"B49","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.1001\/jama.292.19.2372","article-title":"Ozone and short-term mortality in 95 US urban communities, 1987-2000.","volume":"292","author":"Bell","year":"2004","journal-title":"JAMA."},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0169209","article-title":"Effects of exposure to ozone on the ocular surface in an experimental model of allergic conjunctivitis.","volume":"12","author":"Lee","year":"2017","journal-title":"PLoS One."},{"key":"B51","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.freeradbiomed.2013.05.006","article-title":"Effects of ozone exposure on the ocular surface.","volume":"63","author":"Lee","year":"2013","journal-title":"Free Radic Biol Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.909330\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T17:00:45Z","timestamp":1657126845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.909330\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,6]]},"references-count":51,"alternative-id":["10.3389\/fmed.2022.909330"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.909330","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,6]]},"article-number":"909330"}}