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The Adverse Effects of Air Pollution on the Eye: A Review

Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 807, Taiwan
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
Department of Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 812, Taiwan
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(3), 1186;
Submission received: 3 December 2021 / Revised: 14 January 2022 / Accepted: 15 January 2022 / Published: 21 January 2022


Air pollution is inevitably the result of human civilization, industrialization, and globalization. It is composed of a mixture of gases and particles at harmful levels. Particulate matter (PM), nitrogen oxides (NOx), and carbon dioxides (CO2) are mainly generated from vehicle emissions and fuel consumption and are the main materials causing outdoor air pollution. Exposure to polluted outdoor air has been proven to be harmful to human eyes. On the other hand, indoor air pollution from environmental tobacco smoking, heating, cooking, or poor indoor ventilation is also related to several eye diseases, including conjunctivitis, glaucoma, cataracts, and age-related macular degeneration (AMD). In the past 30 years, no updated review has provided an overview of the impact of air pollution on the eye. We reviewed reports on air pollution and eye diseases in the last three decades in the PubMed database, Medline databases, and Google Scholar and discussed the effect of various outdoor and indoor pollutants on human eyes.

1. Introduction

Air is essential for the survival and development of all lives on Earth. Its quality directly influences human health and is closely affected by the extent of civilization. Air pollution is a major contributor to the global burden of disease. There was increased mortality related to air pollution in both developing countries and developed countries such as the United States, despite more rigorous air quality standards [1,2,3]. Although there are many natural sources of air pollution, for example, wildfires and volcanoes, since the Industrial Revolution, human technology has distributed the majority of substantial air pollution. The evolution of human civilization has been accompanied by industrialization and global transportation. Due to the development of industrialization, increasing numbers of fuel-burning motorized vehicles and factories have resulted in high levels of air pollution and poor air quality. For example, according to the Central Weather Bureau of Taiwan, the air quality index (AQI) in south Taiwan, where the main power plants of this island were located, was between 130~160 in January 2021, which is considered harmful to the normal population, and outdoor activities were not suggested.

1.1. The Composition of Air Pollution

Air pollution comprises a complex mixture of gas-phase pollutants and particles at harmful levels that are disbursed into the atmosphere due to either natural or human activities [4]. There are many pollutants in the atmosphere, such as sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon dioxide (CO2), nitrogen monoxide (NO), carbon monoxide (CO), nitrogen oxides (NOx), particulate matter 2.5 (PM2.5), and particulate matter 10 (PM10), mostly generated from burning fuels or industrial production. In addition to traffic and industry activities, daily life activities, including tobacco smoking, household decorating and cooking, also produce COx, NOx, and volatile organic compounds (VOCs). For example, formaldehyde can cause DNA damage in animal cells, and its carcinogenicity has been assessed by many studies in the past three decades [5].
Indoor activities with poor ventilation of buildings in modern life are another cause of health problems. There is an increasing prevalence of asthma, autism, and childhood cancer with everyday exposure to these indoor chemical pollutants [6].

1.2. The Influences of Air Pollution to Human Eyes

Air pollution influences daily living in societies and even jeopardizes the survival of humans. It is widely known that outdoor air pollution influences health. Air pollution induces many health problems and diseases, such as cardiovascular disorders, respiratory tract problems, ocular disease, neurologic disease, cancer, and death [7,8,9,10].
The cornea is the most sensitive structure in the human body due to numerous innervations in the ocular surface and thus is extremely sensitive to environmental agents [11,12]. The eyes defend against potentially harmful external material with only a thin layer of precorneal tear film; as a result, human eyes are susceptible to the adverse effects of air pollution [13].
The adverse effects of air pollutants such as CO, NOx, PM, and O3 on human eyes consist of mostly irritation and inflammation, with conjunctivitis being a frequent problem [14]. Numerous studies have tried to determine the impact of environmental toxins on the ocular surface. Saxena and colleagues found that persons who traveled to highly polluted areas where the PM level was five times higher than the WHO annual average limit of 60 µg/m3 suffered from extensive subclinical ocular surface changes [10]. Versura and associates reported that the mixture of air pollutants led to cytological changes and inflammation in the ocular surface, contributing to eye discomfort [15]. An increasing number of studies have indicated that air pollutants such as PM2.5 are associated with allergic conjunctivitis [16,17] and glaucoma [18,19], and exposure to tobacco smoke can cause cataracts [20]. Moreover, age-related macular degeneration (AMD) is related to exposure to traffic-related air pollutants [21].
Many research investigations have surveyed the association between air quality and outpatient or emergency room visits with respect to respiratory or cardiovascular symptoms. However, only a limited number of studies have investigated the relationship between air pollution and ocular diseases. In the past three decades, no updated review has provided an overview of the impact of air pollution on the eye. This article aimed to determine the significance of the influence of air pollution on the eye and will discuss the effects of various outdoor and indoor pollutants on human eyes by reviewing papers in the last three decades.

2. Material and Methods

The authors performed a review of the literature using PubMed databases, Medline databases and Google Scholar from 1 January 1990, to 31 July 2021. The main inclusion criterion for this review was data on ocular diseases associated with air pollution. The following keywords were used to search the databases: environmental pollution, air pollution, eye disease, ocular disease, acute effect, chronic or long-term effect, ocular surface, inflammation, conjunctivitis, cornea, dry eye, cataract, glaucoma, retinal disease, and retinal vascular disease. Health issues about moisture damage and microbiology-related topics were excluded from this overview. To provide the most up-to-date evidence, we preferred to choose more recent articles that were published in the last five years. The results were restricted to publications in English. Totally, 28 review papers and 83 research papers were cited in the review paper.

3. Results and Discussion

There are multitudes of studies elucidating that environmental pollution is harmful to the health of human organ systems, including the skin, oropharyngeal, and respiratory systems [1,2,7,8,9,10]. Eyes, as the most important sensory organs, are inevitably the first to be affected by air pollution. Therefore, in the past three decades, the number of studies evaluating the harmful effects of air pollution on the eye has increased.
Our analysis of the relevant studies included in this narrative review (see Table 1) demonstrated that the most common ophthalmologic disorder related to air pollution was inflammation of the conjunctiva (conjunctivitis). Figure 1 illustrates the outline of this article and the impact of air pollution on the eye. Here, we discuss each adverse effect of air pollution according to the origin of the compound.

3.1. Outdoor Air Pollution

Outdoor air pollution is a significant public health problem in population centers worldwide. For decades, studies have demonstrated a strong association between air pollution and a spectrum of ill health effects. Outdoor air pollution is a major environmental health hazard that was associated with 3.7 million deaths worldwide in 2012 [46] and 4.2 million deaths in 2016 [47]. The increasing trend in attributable deaths from 1990 to 2015 was partially due to the increase in outdoor air pollution levels in low- and middle-income countries [1]. In 2016, the International Agency for Research on Cancer (IARC) classified outdoor air pollution as a human carcinogen, according to adequate evidence, especially for lung cancer [48]. Automobile traffic is the predominant source of outdoor air pollution in developed urban areas. The components of outdoor air pollution are complicated and dynamic and include ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), lead (Pb), carbon monoxide (CO), and particulate matter (PM). The components vary seasonally and are affected by human activity and climatic events [49]. PM is further classified into coarse PM (PM10, PM with an aerodynamic diameter ≤ 10 μm), fine PM (PM2.5, PM with an aerodynamic diameter ≤ 2.5 μm), and ultrafine PM (PM1.0, PM with an aerodynamic diameter ≤ 1.0 μm) [50].
Pollutants originate from different sources. For example, NO2 and ground-level O3 (which derives from the effect of ultraviolet light on nitrogen dioxide) are primarily emitted from vehicle exhaust systems, while SO2 originates from the burning of sulfur-containing fuels (e.g., coal-burning plants). Coarse PM primarily results from scattered ground or airborne dust; fine and ultrafine PM derive primarily from vehicular exhaust [51]. Coarse and fine particulates differ in not only their physical properties and size but also their chemical components. PM10 primarily consists of geological materials, in comparison to PM2.5 and PM1.0, which have larger fragments of elemental and organic carbon [52]. These variations in PM chemical composition are related to different toxicity profiles and can be used as tracers of vehicular emanations. For example, elemental carbon can be used to track traffic-related emissions [53]. Outdoor air pollution consists of both primary pollutants released directly into the atmosphere and secondary pollutants formed in the air due to chemical transformation of primary pollutants. These chemical reactions are affected by temperature and thus can be affected by global climate warming. In addition, accumulated evidence has implied that air pollution can not only exacerbate ocular symptoms but also cause new-onset ocular disease. Table 2 demonstrates the 2021 World Health Organization (WHO) air quality guidelines, which were tightened following recommendations in 2005. According to the UN organization, the new recommendations reflect the recent evidence of the significantly higher-than-thought impact of even lower concentrations of air pollution on human health and wellbeing. A recent study estimated the death toll of air pollution at 8.7 million per year [54].

3.1.1. Ocular Surface Diseases (OSDs)

Traffic- and industry-related airborne byproducts account for most outdoor air pollution. For example, in New Delhi, India, the transportation component of air pollution was 72%, and the industry component was 20% in 2003. The level of suspended particulate matter (SPM) in New Delhi was five times higher than the annual average control limit of 60 mg/m3 set by the World Health Organization (WHO). One study showed that people in New Delhi who commuted daily to the workplace using open vehicles (e.g., scooters, motorcycles, or bicycles) for more than 10 years had more ocular surface symptoms, such as redness, irritation, lacrimation, burning, and dryness, than people living near their workplace [10]. NO and NO2, the primary products of diesel oil consumption by trucks and large vehicles, can travel long distances. A study indicated that higher nitric oxide (NO) and NO2 concentrations were related to more severe conjunctivitis in people in Paris [24]. Another study from Taiwan reported that visiting an ophthalmologic outpatient clinic was associated with an increased chance of visiting an ophthalmology clinic for nonspecific conjunctivitis due to increased exposure to PM10 and PM2.5, NO2, SO2, and O3 [25]. Conjunctival disease caused by air pollution can manifest as subclinical ocular surface changes [55] that frequently cause major discomfort, such as burning and grittiness, and require a clinical visit. Moreover, persistent exposure to air pollution can result in cellular transformation, including goblet-cell hyperplasia in the human conjunctival epithelium [56]. Discomfort due to eye disorders can disrupt people’s daily work efficiency and reduce road traffic safety.
In addition, air pollution may exacerbate dry eye disease [57]. Dysfunction of the tear film is considered to be caused by two interrelated mechanisms: hyperosmolarity and tear film instability [58]. Tear hyperosmolarity may lead to changes on the ocular surface by inducing a series of inflammatory events in the ocular epithelium, which induce the expression of inflammatory mediators in the tear film. Consequent damage to the epithelium causes cell death via apoptosis, loss of goblet cells and decreased mucin production, leading to tear film instability. This instability subsequently disrupts the hyperosmolarity of the ocular surface, intensifying a vicious cycle [59]. A study induced dry eye syndrome in mice with PM2.5 eyedrops, and apoptosis of corneal superficial and basal epithelial cells was observed [60].

3.1.2. Glaucoma

Among air pollutants, PM2.5 is one of the strongest and most consistent predictors of mortality. It is associated with pulmonary and cardiovascular disease and central nervous system conditions such as Alzheimer’s disease, Parkinson’s disease, and stroke [1]. Wang and associates reported that glaucoma was positively related to national levels of PM2.5 [18]. PM2.5 has been shown to be toxic to intraocular tissues and contribute to the development of ocular hypertension and glaucoma. Mechanistically, PM2.5 and PM10 induce the production of NO and interleukin 8, causing increased oxidative stress [61]. Furthermore, PM2.5 also increased oxidative stress and induced NLRP3 inflammasome-mediated pyroptosis, a form of nonapoptotic cell death in trabecular meshwork cells, in an in vitro study [62]. Another study also reported that PM2.5 exposure inhibited the proliferation of and increased apoptosis in neural retina cells, resulting in the abnormal development of the neural retina [63].
According to the results of a UK Biobank study, participants in areas with higher PM2.5 concentrations were more likely to report a diagnosis of glaucoma and to have a thinner macular ganglion cell–inner plexiform layer (GCIPL), as measured by spectral-domain optical coherence tomography (SD-OCT), than their counterparts [19]. There was no association between intraocular pressure (IOP) and PM2.5 exposure, suggesting that the relationship may occur through a pressure-independent mechanism, possibly neurotoxic and/or vascular effects [19]. Sun and associates designed a nested case–control study to investigate whether exposure to PM2.5 was related to the diagnosis of primary open-angle glaucoma (POAG) in Taiwanese adults [28]. They found that increased exposure to PM2.5 was associated with the incidence of POAG. In a retrospective cohort study, Min and colleagues evaluated whether exposure to PM10 was related to the occurrence of childhood glaucoma [30]. Their results demonstrated that short-term and long-term exposure to PM10 increased the probability of developing childhood glaucoma. This finding implies that PM10 exposure may be a risk factor for childhood glaucoma.

3.1.3. Retinopathy and Maculopathy

Air pollution can induce oxidative stress, activate inflammatory pathways, and increase coagulation [64,65,66]. The retina is susceptible to oxidative stress due to its high consumption of oxygen and high proportion of polyunsaturated fatty acids and exposure to visible light [67]. In addition, oxidative damage increases with age, leading to retinal dysfunction and cell loss. A study reported that epithelial–mesenchymal transition (EMT) and activation downstream of cellular reactive oxygen species (ROS) may be responsible for PM2.5-induced dysfunction in retinal cells [68]. As a result, the aging retina is potentially particularly susceptible to damage caused by air pollution. There are studies describing myopic macular degeneration, age-related macular degeneration, and diabetic retinopathy in association with air pollution [26,27,29,69]. In one study, exposure to PM2.5 and NOx was reported to increase ocular surface inflammation and retinal inflammation, increasing the risk of developing myopic macular diseases [26]. A UK Biobank study including more than 50,000 people demonstrated that exposure to higher PM2.5 and PM10 concentrations and more PM2.5 absorbance were associated with inner and outer retinal layer thinning [29]. Another 10-year cohort study analyzing links between the national health database and the air quality database showed that chronic exposure to a higher concentration of ambient NO2 or CO significantly increased the risk of AMD [21]. One study from Taiwan demonstrated a positive association between diabetic retinopathy and PM ≤ 2.5 and 2.5 to 10 μm in diameter, with odds ratios of 1.29 (1.11–1.50) and 1.37 (1.17–1.61), respectively [69]. In a national cross-sectional study in rural China, Shan et al. enrolled 3111 diabetic patients, 329 of whom had diabetic retinopathy [27]. Their results showed that increased exposure to a high concentration of PM2.5 was related to an increased risk of diabetic retinopathy (DR) among diabetic patients in rural China. They postulated that PM could raise glucose levels and induce oxidative stress, inflammation, specific cytokine activity, and endothelial dysfunction, contributing to diabetic retinopathy.

3.2. Indoor Air Pollution

Indoor air pollution is associated with indoor tobacco smoking, dissipation of compounds used in building materials and decorations in buildings, cooking with oil and high heat, burning coal or biomass for cooking or heating, using pesticides, etc. [70,71]. Moreover, building products and materials, cleaning products, and consumer products emit many chemically nonreactive volatile organic compounds (VOCs) and biologically reactive compounds, such as formaldehyde (FA) and acrolein.
Several VOCs, especially aldehydes, have low odor thresholds [72]. This influences the perceived indoor air quality and possibly overall sensory symptoms [73]. Therefore, personality factors, such as expectations about odor, anxiety level, or attitude toward health risks, may affect complaints of symptoms [74].
Exposure to high concentrations of indoor air pollutants, for example, concentrations of carbon monoxide at 60 × 103 µg/m3 for 30 min or 100 × 103 µg/m3 for 15 min, could lead to health effects [75]. Examples of acute effects are exacerbation of allergic symptoms, such as conjunctivitis, rhinitis, atopic dermatitis, and intoxication or death due to short-term exposure to very high concentrations of carbon monoxide [76]. Examples of chronic health effects include cancer and noncancer effects related to VOCs [77], respiratory diseases associated with secondhand tobacco smoke (e.g., chronic obstructive pulmonary disease (COPD)) [78], elevated susceptibility to respiratory infections, and cardiovascular disease [38]. Some pollutants, including tobacco smoke and other combustion products, may exacerbate asthma symptoms [79], whereas FA and other VOCs have been associated with sick building syndrome (SBS) [80].
These indoor air pollutants are reported to be harmful to the human eye, as discussed below.

3.2.1. Ocular Surface Disease

Tobacco smoking affects the ocular surface, resulting in symptoms such as itchiness, redness, and irritation of the eyes. The changes on the ocular surface include alteration of the lipid layer of the tear film, reduced tear secretion, and decreased corneal and conjunctival sensitivity and can cause disorders such as atopic kerato-conjunctivitis and allergic conjunctivitis. Tanisha et al. reported that aldehydes and free radicals released from electronic cigarettes may disturb the stability of the tear film, and vape flavoring may damage the lipid layer through peroxidation. Furthermore, nicotine and acrolein in cigarette vapors cause an inflammatory response in corneal epithelial cells [22,23].
Indoor smoking can cause an increased level of PM2.5 that is 10 times higher than that in nonsmoking homes. Long-term exposure to fine PM induced oxidative stress in human corneal epithelial-transformed (HCE) cells and altered the cytokine content of tears; moreover, inflammation of the ocular surface and dry eye syndrome subsequently developed in a mouse model [43]. According to a questionnaire study, 82% of participants with household indoor tobacco smoking exposure reported eye irritation [81]. In addition, a large cross-sectional study including over 14,500 adolescents in France showed that environmental tobacco smoke exposure increased the risk of rhinoconjunctivitis by 20% [45].
Indoor smoke can be produced by other sources, such as cookstoves. For example, a study in Guatemala showed that more than 60% of women who used cookstoves for cooking reported that their eyes were always irritated. However, when these participants were divided into those with exposure to miniature chimney stoves and those with exposure to open stoves, the chimney stove group had less eye irritation than the open stove group [82].
Many in vivo and in vitro studies have focused on outdoor air pollution-induced eye disease; however, other studies have revealed correlations between eye diseases and indoor air pollutants. For example, Vitoux’s in vitro study investigated the cytotoxic and inflammatory responses of the conjunctival cell line WKD exposed to combinations of environmental pollutants, such as air–liquid interface conditions combining low humidity, airflow, and formaldehyde gas, to mimic the inflammatory responses observed in dry eye patients [35]. Furthermore, the in vivo study by Suneel et al. investigated acrolein toxicity in rabbit eyes [31]. The results of Suneel showed that topical or vapor application of acrolein severely injured rabbit eyes and led to a series of ocular pathologies, such as swelling of the eye, ocular surface inflammation, abnormalities, irregular collagen accumulation, and corneal opacity. Additionally, Li et al.’s study evaluated long-term cigarette smoke exposure using both in vivo mice and the in vitro conjunctival cell line HCEC, and their results showed that cigarette smoke stimulates ocular surface changes with dry eye, which may be correlated with inflammation and activation of the NF-κB pathway [44].

3.2.2. Glaucoma

Cigarette smoking is associated with many chronic disorders that have been considered serious global public health problems. However, investigations on the correlation between smoking and ocular disorders are scarce. Mechanistically, cigarette smoke extract (CSE) caused injury in primary rat retinal ganglion cells (RGCs) via apoptosis and autophagy by upregulating the mRNA levels of proapoptotic Bad and Bax and the protein level of the autophagy marker LC3B II [33]. This mechanism contributes to the development and progression of glaucoma [34].
Blue Mountains Eye Study data implied a moderate positive association between smoking and elevated IOP (a significant risk factor for glaucoma) [83]. A systematic review to evaluate the association between cigarette smoking and POAG included 17 papers in the final analysis. Their results showed that the link between current smoking and POAG was stronger than that between past smoking and POAG, and recent studies have implied that heavy smoking may elevate the risk of POAG [84]. In a prospective and dynamic cohort study, Pérez-de-Arcelus et al. enrolled 16,797 participants without glaucoma and followed them for a median of 8.5 years. In the 8.5-year follow-up period, 184 new glaucoma cases were diagnosed. Current smoking was associated with a higher glaucoma incidence than never smoking [85].

3.2.3. Cataract

Cataracts have long been linked to cigarette smoking [86]. The mechanism may be direct or indirect effects of inhaled toxic substances on lens tissues. A study enrolled 3924 subjects in rural southern India to investigate the impact of tobacco use on cataract formation; the results demonstrated that cataract formation was significantly associated with tobacco use [20]. Although the exact compounds in cigarettes responsible for lens toxicity are unknown, one compound, naphthalene, is known to be cataractogenic and is used to induce cataracts in rat models [36,37]. Naphthalene, along with another metal toxin, Pb, is also found in biomass fuel (BMF) smoke. The production of smoke during the consumption of this fuel can cause cataract formation [87]. A systematic review of the impact of tobacco smoking on the pathogenesis of many disorders of the anterior segment of the eye in adults and children reported that smoking was a strong risk factor for age-related nuclear cataracts [88].
One-third of the world’s population burns organic material, including wood, feces, or charcoal (BMF), for cooking, heating, and lighting. This form of energy usage is related to high levels of indoor air pollution and an increase in the incidence of respiratory diseases, cardiovascular disorders, and cataracts [89]. Epidemiological research from India and Nepal has shown that indoor cooking using BMF is related to cataracts and blindness [90,91]. Smoke causes oxidative stress and consumes plasma ascorbate, carotenoids, and glutathione, which offer antioxidant protection against cataract formation.

3.2.4. Uveitis

As uveitis develops due to immune dysregulation, data on the association between smoking and uveitis are rare. An epidemiological study in the American adult population using data from the National Health and Nutrition Examination Survey (NHANES) for 2009 and 2010 demonstrated that smoking was positively associated with uveitis [92]. The Pacific Ocular Inflammation Study implied that cigarette smoking was significantly associated with new-onset uveitis [93]. There is a stronger association between smoking and noninfectious uveitis. In a retrospective case–control study, Lin and associates reported that smoking was related to both infectious and noninfectious uveitis [94]. An observational cross-sectional study enrolled 350 patients with noninfectious uveitis. Roesel and colleagues found that smoking had a positive association with uveitis activity, resulting in an increased dose of steroid eye drops and increased occurrence of cataract and macular edema [95].
Chronic exposure to ROS in cigarette smoke upregulates the expression of TLR4 by human macrophages, promoting NF-κB activation and the production of interleukin (IL)-8 [96,97]. Nicotine plays a similar role in neutrophils by generating peroxynitrite, a nitrate isomer that binds acetylcholine receptors to promote NF-κB-mediated cytokine IL-8 transcription [39,97]. Increased concentrations of IL-8, as found in the aqueous humor (AqH) in uveitis, act together with IL-6 and TNF-α to facilitate the migration and activation of macrophages that assault the uvea [40,41,42].
Several carcinogenic compounds cause Th17 cell expansion by binding aryl hydrocarbon receptors on memory T cells [98,99]. The resultant increase in the Th17 population results in the elevated secretion of IL-17 and IL-22, which conversely facilitate the migration and extravasation of leukocytes into various tissues [100]. Updated data have thus suggested that Th17 cells play a role in the pathological mechanism of not only uveitis but also multiple sclerosis, rheumatoid arthritis, and psoriasis [100,101,102,103,104,105]. This shared pathogenesis perhaps illustrates why smoking is related to several and often concomitantly occurring autoimmune disorders.

3.2.5. Retinal and Macular Diseases

Previous studies have shown that cigarette smoking is related to an increased risk of AMD [106]. Regarding environmental cigarette smoke exposure, a case–control study showed increased risks of neovascular and atrophic AMD [107]. However, in the Blue Mountains Eye Study, Smith and associates found that passive smoking does not significantly increase the risk for late AMD [108]. Cigarette vapor was reported to accelerate the progression of inflammation and angiogenesis in the retina of mice, which were possibly associated with the onset of wet AMD [109]. In addition, nicotine inhaled in passive smoking increased the VEGF-to-PEDF ratio in RPE cells in an in vitro study. This alteration in the ratio may play a key role in the progression to wet AMD in passive smokers [110].
A systematic review of the impact of direct tobacco smoking on the pathogenesis of many disorders of the posterior segment of the eye in adults and children revealed that tobacco smoking had a positive association with AMD, polypoidal choroidal vasculopathy, and inflamed cystoid macular edema in adults. Tobacco smoking decreases retinal and choroidal thickness. In addition, maternal smoking is a significant risk factor for stage 3 and 4 retinopathy of prematurity and a thinner retinal nerve fiber layer in children [111]. Govindaraju et al. reported cigarette smoke-induced proteostasis and autophagy impairment, which may be associated with AMD pathogenesis, in retinal pigmental ARPE-19 cells [32].
Household fuel consumption is related to an increased indoor concentration of fine particles. Exposure to fine particles associated with solid fuel use causes systemic inflammatory responses and cytokine production. To our knowledge, AMD is due to genetic polymorphisms, and innate immune reactions and inflammation are recognized as etiologies. Although there is a lack of evidence, chronic inflammation induced by indoor air pollution is a possible cause of AMD [70].

4. Conclusions

Outdoor and indoor air pollution is derived from different sources and can cause different eye diseases. Ocular surface irrigation, conjunctivitis and dry eye disease are the most direct results of air pollution. However, chronic inflammation, oxidative stress, and toxicity resulting from air pollution can further cause cataracts, glaucoma, uveitis, retinal layer thinning, macular degeneration, and diabetic retinopathy. Further research on the effects of air pollution on retinal ganglion cells and the chorioretinal vasculature may help identify the underlying pathological mechanisms. In addition, further research on the association between air pollutants and ophthalmological disorders is needed to improve the understanding of exposure patterns and ocular effects. Such studies will help determine the long-term impacts of air pollutants on the eye, which are currently unknown.

Author Contributions

K.-C.C. and C.-C.L. designed the experiments and wrote the paper. K.-C.C., C.-C.C., and C.-X.H. collected the data. S.-K.H. prepared and organized the table. C.-C.L., C.-C.C., and K.-C.C. wrote the draft. K.-C.C., P.-Y.L., K.-J.C., and S.-K.H. checked and edited the manuscript. All authors have read and agreed to the published version of the manuscript.


This study was financially supported by grants KMHK-108-032, KMHK-109-035and H-110-004 from Kaohsiung Municipal Siaogang Hospital, Taiwan and grants MOST 108-2314-B-037-088, 109-2314-B-037-069-MY3 and 110-2314-B-037-112 from the Ministry of Science and Technology, Taiwan.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.


We are thankful to the abovementioned organizations that provided financial support.

Conflicts of Interest

The authors declare that there are no conflict of interest.


  1. Cohen, A.J.; Brauer, M.; Burnett, R.; Anderson, H.R.; Frostad, J.; Estep, K.; Balakrishnan, K.; Brunekreef, B.; Dandona, L.; Dandona, R.; et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: An analysis of data from the Global Burden of Diseases Study 2015. Lancet 2017, 389, 1907–1918. [Google Scholar] [CrossRef] [Green Version]
  2. Di, Q.; Wang, Y.; Zanobetti, A.; Wang, Y.; Koutrakis, P.; Choirat, C.; Dominici, F.; Schwartz, J.D. Air Pollution and Mortality in the Medicare Population. N. Engl. J. Med. 2017, 376, 2513–2522. [Google Scholar] [CrossRef] [PubMed]
  3. Abellán, R.; Mansego, M.L.; Martínez-Hervás, S.; Martín-Escudero, J.C.; Carmena, R.; Real, J.T.; Redon, J.; Castrodeza-Sanz, J.J.; Chaves, F.J. Association of selected ABC gene family single nucleotide polymorphisms with postprandial lipoproteins: Results from the population-based Hortega study. Atherosclerosis 2010, 211, 203–209. [Google Scholar] [CrossRef]
  4. Kemp, A.C.; Horton, B.P.; Donnelly, J.P.; Mann, M.E.; Vermeer, M.; Rahmstorf, S. Climate related sea-level variations over the past two millennia. Proc. Natl. Acad. Sci. USA 2011, 108, 11017–11022. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  5. Swenberg, J.A.; Moeller, B.C.; Lu, K.; Rager, J.E.; Fry, R.C.; Starr, T.B. Formaldehyde carcinogenicity research: 30 years and counting for mode of action, epidemiology, and cancer risk assessment. Toxicol. Pathol. 2013, 41, 181–189. [Google Scholar] [CrossRef] [Green Version]
  6. Zhang, J.; Smith, K.R. Indoor air pollution: A global health concern. Br. Med. Bull. 2003, 68, 209–225. [Google Scholar] [CrossRef] [Green Version]
  7. Eftim, S.E.; Samet, J.M.; Janes, H.; McDermott, A.; Dominici, F. Fine particulate matter and mortality: A comparison of the six cities and American Cancer Society cohorts with a medicare cohort. Epidemiology 2008, 19, 209–216. [Google Scholar] [CrossRef]
  8. Pope, C.A., 3rd. Air pollution and health-good news and bad. N. Engl. J. Med. 2004, 351, 1132–1134. [Google Scholar] [CrossRef] [Green Version]
  9. Pope, C.A., 3rd; Dockery, D.W. Health effects of fine particulate air pollution: Lines that connect. J. Air. Waste Manag. Assoc. 2006, 56, 709–742. [Google Scholar] [CrossRef]
  10. Saxena, R.; Srivastava, S.; Trivedi, D.; Anand, E.; Joshi, S.; Gupta, S.K. Impact of environmental pollution on the eye. Acta Ophthalmol. Scand. 2003, 81, 491–494. [Google Scholar] [CrossRef] [PubMed]
  11. Tuominen, I.S.; Konttinen, Y.T.; Vesaluoma, M.H.; Moilanen, J.A.; Helintö, M.; Tervo, T.M. Corneal innervation and morphology in primary Sjögren’s syndrome. Invest. Ophthalmol. Vis. Sci. 2003, 44, 2545–2549. [Google Scholar] [CrossRef] [Green Version]
  12. Al-Aqaba, M.A.; Dhillon, V.K.; Mohammed, I.; Said, D.G.; Dua, H.S. Corneal nerves in health and disease. Prog. Retin. Eye Res. 2019, 73, 100762. [Google Scholar] [CrossRef]
  13. Koh, S.; Tung, C.I.; Inoue, Y.; Jhanji, V. Effects of tear film dynamics on quality of vision. Br. J. Ophthalmol. 2018, 102, 1615–1620. [Google Scholar] [CrossRef]
  14. Schwela, D. Air pollution and health in urban areas. Rev. Environ. Health 2000, 15, 13–42. [Google Scholar] [CrossRef] [PubMed]
  15. Versura, P.; Profazio, V.; Cellini, M.; Torreggiani, A.; Caramazza, R. Eye discomfort and air pollution. Ophthalmologica 1999, 213, 103–109. [Google Scholar] [CrossRef] [PubMed]
  16. Mimura, T.; Ichinose, T.; Yamagami, S.; Fujishima, H.; Kamei, Y.; Goto, M.; Takada, S.; Matsubara, M. Airborne particulate matter (PM2.5) and the prevalence of allergic conjunctivitis in Japan. Sci. Total Environ. 2014, 487, 493–499. [Google Scholar] [CrossRef]
  17. Hong, J.; Zhong, T.; Li, H.; Xu, J.; Ye, X.; Mu, Z.; Lu, Y.; Mashaghi, A.; Zhou, Y.; Tan, M.; et al. Ambient air pollution, weather changes, and outpatient visits for allergic conjunctivitis: A retrospective registry study. Sci. Rep. 2016, 6, 23858. [Google Scholar] [CrossRef] [Green Version]
  18. Wang, W.; He, M.; Li, Z.; Huang, W. Epidemiological variations and trends in health burden of glaucoma worldwide. Acta Ophthalmol. 2019, 97, e349–e355. [Google Scholar] [CrossRef] [Green Version]
  19. Chua, S.Y.L.; Khawaja, A.P.; Morgan, J.; Strouthidis, N.; Reisman, C.; Dick, A.D.; Khaw, P.T.; Patel, P.J.; Foster, P.J. The Relationship Between Ambient Atmospheric Fine Particulate Matter (PM2.5) and Glaucoma in a Large Community Cohort. Invest Ophthalmol. Vis. Sci. 2019, 60, 4915–4923. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  20. Raju, P.; George, R.; Ve Ramesh, S.; Arvind, H.; Baskaran, M.; Vijaya, L. Influence of tobacco use on cataract development. Br. J. Ophthalmol. 2006, 90, 1374–1377. [Google Scholar] [CrossRef] [Green Version]
  21. Chang, K.-H.; Hsu, P.-Y.; Lin, C.-J.; Lin, C.-L.; Juo, S.-H.H.; Liang, C.-L. Traffic-related air pollutants increase the risk for age-related macular degeneration. J. Investig. Med. 2019, 67, 1076. [Google Scholar] [CrossRef] [PubMed]
  22. Jetten, N.; Verbruggen, S.; Gijbels, M.J.; Post, M.J.; De Winther, M.P.; Donners, M.M. Anti-inflammatory M2, but not pro-inflammatory M1 macrophages promote angiogenesis in vivo. Angiogenesis 2014, 17, 109–118. [Google Scholar] [CrossRef] [PubMed]
  23. Ambient (Outdoor) Air Quality and Health. Available online: (accessed on 22 September 2021).
  24. Aitio, A.; Axelson, O.; Blair, A.; Bond, J.A.; Bucher, J.R.; Caldwell, J.; Coggon, D.; Demers, P.A.; Dragani, T.A.; Elcombe, C.R.; et al. Outdoor Air Pollution. IARC Monogr. Eval. Carcinog. Risks Hum. 2016, 109, 9–444. [Google Scholar]
  25. Huff, R.D.; Carlsten, C.; Hirota, J.A. An update on immunologic mechanisms in the respiratory mucosa in response to air pollutants. J. Allergy Clin. Immunol. 2019, 143, 1989–2001. [Google Scholar] [CrossRef]
  26. Kappos, A.D.; Bruckmann, P.; Eikmann, T.; Englert, N.; Heinrich, U.; Höppe, P.; Koch, E.; Krause, G.H.; Kreyling, W.G.; Rauchfuss, K.; et al. Health effects of particles in ambient air. Int. J. Hyg. Environ. Health 2004, 207, 399–407. [Google Scholar] [CrossRef]
  27. Holguin, F. Traffic, outdoor air pollution, and asthma. Immunol. Allergy Clin. N. Am. 2008, 28, 577–588. [Google Scholar] [CrossRef] [PubMed]
  28. Hetland, R.B.; Cassee, F.R.; Låg, M.; Refsnes, M.; Dybing, E.; Schwarze, P.E. Cytokine release from alveolar macrophages exposed to ambient particulate matter: Heterogeneity in relation to size, city and season. Part. Fibre Toxicol. 2005, 2, 4. [Google Scholar] [CrossRef] [Green Version]
  29. McCreanor, J.; Cullinan, P.; Nieuwenhuijsen, M.J.; Stewart-Evans, J.; Malliarou, E.; Jarup, L.; Harrington, R.; Svartengren, M.; Han, I.K.; Ohman-Strickland, P.; et al. Respiratory effects of exposure to diesel traffic in persons with asthma. N. Engl. J. Med. 2007, 357, 2348–2358. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  30. Vohra, K.; Vodonos, A.; Schwartz, J.; Marais, E.A.; Sulprizio, M.P.; Mickley, L.J. Global mortality from outdoor fine particle pollution generated by fossil fuel combustion: Results from GEOS-Chem. Environ. Res. 2021, 195, 110754. [Google Scholar] [CrossRef]
  31. Bourcier, T.; Viboud, C.; Cohen, J.C.; Thomas, F.; Bury, T.; Cadiot, L.; Mestre, O.; Flahault, A.; Borderie, V.; Laroche, L. Effects of air pollution and climatic conditions on the frequency of ophthalmological emergency examinations. Br. J. Ophthalmol. 2003, 87, 809–811. [Google Scholar] [CrossRef] [Green Version]
  32. Chang, C.J.; Yang, H.H.; Chang, C.A.; Tsai, H.Y. Relationship between air pollution and outpatient visits for nonspecific conjunctivitis. Invest. Ophthalmol. Vis. Sci. 2012, 53, 429–433. [Google Scholar] [CrossRef] [Green Version]
  33. Torricelli, A.; Novaes, P.; Matsuda, M.; Alves, M.; Monteiro, M. Ocular surface adverse effects of ambient levels of air pollution. Arq. Bras. De Oftalmol. 2011, 74, 377–381. [Google Scholar] [CrossRef] [Green Version]
  34. Novaes, P.; do Nascimento Saldiva, P.H.; Kara-José, N.; Macchione, M.; Matsuda, M.; Racca, L.; Berra, A. Ambient levels of air pollution induce goblet-cell hyperplasia in human conjunctival epithelium. Environ. Health Perspect. 2007, 115, 1753–1756. [Google Scholar] [CrossRef] [Green Version]
  35. Zhong, J.-Y.; Lee, Y.-C.; Hsieh, C.-J.; Tseng, C.-C.; Yiin, L.-M. Association between Dry Eye Disease, Air Pollution and Weather Changes in Taiwan. Int. J. Environ. Res. Public Health 2018, 15, 2269. [Google Scholar] [CrossRef] [Green Version]
  36. Liu, H.; Begley, C.; Chen, M.; Bradley, A.; Bonanno, J.; McNamara, N.A.; Nelson, J.D.; Simpson, T. A link between tear instability and hyperosmolarity in dry eye. Invest. Ophthalmol. Vis. Sci. 2009, 50, 3671–3679. [Google Scholar] [CrossRef] [PubMed]
  37. Bron, A.J.; Abelson, M.B.; Ousler, G.; Pearce, E.; Tomlinson, A.; Yokoi, A.; Smith, J.A.; Begley, C.; Caffery, B.; Nichols, K. Methodologies to diagnose and monitor dry eye disease: Report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul. Surf. 2007, 5, 108–152. [Google Scholar]
  38. Tan, G.; Li, J.; Yang, Q.; Wu, A.; Qu, D.Y.; Wang, Y.; Ye, L.; Bao, J.; Shao, Y. Air pollutant particulate matter 2.5 induces dry eye syndrome in mice. Sci. Rep. 2018, 8, 17828. [Google Scholar] [CrossRef] [Green Version]
  39. Yoon, S.; Han, S.; Jeon, K.J.; Kwon, S. Effects of collected road dusts on cell viability, inflammatory response, and oxidative stress in cultured human corneal epithelial cells. Toxicol. Lett. 2018, 284, 152–160. [Google Scholar] [CrossRef] [PubMed]
  40. Li, L.; Xing, C.; Zhou, J.; Niu, L.; Luo, B.; Song, M.; Niu, J.; Ruan, Y.; Sun, X.; Lei, Y. Airborne particulate matter (PM2.5) triggers ocular hypertension and glaucoma through pyroptosis. Part. Fibre Toxicol. 2021, 18, 10. [Google Scholar] [CrossRef]
  41. Zeng, Y.; Li, M.; Zou, T.; Chen, X.; Li, Q.; Li, Y.; Ge, L.; Chen, S.; Xu, H. The Impact of Particulate Matter (PM2.5) on Human Retinal Development in hESC-Derived Retinal Organoids. Front. Cell Dev. Biol. 2021, 9, 607341. [Google Scholar] [CrossRef] [PubMed]
  42. Sun, H.Y.; Luo, C.W.; Chiang, Y.W.; Yeh, K.L.; Li, Y.C.; Ho, Y.C.; Lee, S.S.; Chen, W.Y.; Chen, C.J.; Kuan, Y.H. Association Between PM2.5 Exposure Level and Primary Open-Angle Glaucoma in Taiwanese Adults: A Nested Case-Control Study. Int. J. Environ. Res. Public Health 2021, 18, 1714. [Google Scholar] [CrossRef]
  43. Min, K.B.; Min, J.Y. Association of Ambient Particulate Matter Exposure with the Incidence of Glaucoma in Childhood. Am. J. Ophthalmol. 2020, 211, 176–182. [Google Scholar] [CrossRef]
  44. Lodovici, M.; Bigagli, E. Oxidative stress and air pollution exposure. J. Toxicol. 2011, 2011, 487074. [Google Scholar] [CrossRef]
  45. Baccarelli, A.; Zanobetti, A.; Martinelli, I.; Grillo, P.; Hou, L.; Giacomini, S.; Bonzini, M.; Lanzani, G.; Mannucci, P.M.; Bertazzi, P.A.; et al. Effects of exposure to air pollution on blood coagulation. J. Thromb. Haemost. 2007, 5, 252–260. [Google Scholar] [CrossRef]
  46. Brook, R.D.; Rajagopalan, S.; Pope, C.A., 3rd; Brook, J.R.; Bhatnagar, A.; Diez-Roux, A.V.; Holguin, F.; Hong, Y.; Luepker, R.V.; Mittleman, M.A.; et al. Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation 2010, 121, 2331–2378. [Google Scholar] [CrossRef] [Green Version]
  47. Jarrett, S.G.; Boulton, M.E. Consequences of oxidative stress in age-related macular degeneration. Mol. Asp. Med. 2012, 33, 399–417. [Google Scholar] [CrossRef] [Green Version]
  48. Lee, H.; Hwang-Bo, H.; Ji, S.Y.; Kim, M.Y.; Kim, S.Y.; Park, C.; Hong, S.H.; Kim, G.Y.; Song, K.S.; Hyun, J.W.; et al. Diesel particulate matter2.5 promotes epithelial-mesenchymal transition of human retinal pigment epithelial cells via generation of reactive oxygen species. Environ. Pollut. 2020, 262, 114301. [Google Scholar] [CrossRef]
  49. Wei, C.C.; Lin, H.J.; Lim, Y.P.; Chen, C.S.; Chang, C.Y.; Lin, C.J.; Chen, J.J.; Tien, P.T.; Lin, C.L.; Wan, L. PM2.5 and NOx exposure promote myopia: Clinical evidence and experimental proof. Environ. Pollut. 2019, 254, 113031. [Google Scholar] [CrossRef]
  50. Chua, S.Y.L.; Khawaja, A.P.; Dick, A.D.; Morgan, J.; Dhillon, B.; Lotery, A.J.; Strouthidis, N.G.; Reisman, C.; Peto, T.; Khaw, P.T.; et al. Ambient Air Pollution Associations with Retinal Morphology in the UK Biobank. Investig. Ophthalmol. Vis. Sci. 2020, 61, 32. [Google Scholar] [CrossRef]
  51. Pan, S.C.; Huang, C.C.; Chin, W.S.; Chen, B.Y.; Chan, C.C.; Guo, Y.L. Association between air pollution exposure and diabetic retinopathy among diabetics. Environ. Res. 2020, 181, 108960. [Google Scholar] [CrossRef]
  52. Shan, A.; Chen, X.; Yang, X.; Yao, B.; Liang, F.; Yang, Z.; Liu, F.; Chen, S.; Yan, X.; Huang, J.; et al. Association between long-term exposure to fine particulate matter and diabetic retinopathy among diabetic patients: A national cross-sectional study in China. Environ. Int. 2021, 154, 106568. [Google Scholar] [CrossRef]
  53. West, S.K.; Bates, M.N.; Lee, J.S.; Schaumberg, D.A.; Lee, D.J.; Adair-Rohani, H.; Chen, D.F.; Araj, H. Is household air pollution a risk factor for eye disease? Int. J. Environ. Res. Public Health 2013, 10, 5378–5398. [Google Scholar] [CrossRef] [Green Version]
  54. Kabir, E.; Kim, K.H. An investigation on hazardous and odorous pollutant emission during cooking activities. J. Hazard. Mater. 2011, 188, 443–454. [Google Scholar] [CrossRef]
  55. Wolkoff, P. External eye symptoms in indoor environments. Indoor Air 2017, 27, 246–260. [Google Scholar] [CrossRef]
  56. Wolkoff, P. Indoor air pollutants in office environments: Assessment of comfort, health, and performance. Int. J. Hyg. Environ. Health 2013, 216, 371–394. [Google Scholar] [CrossRef]
  57. Jaén, C.; Dalton, P. Asthma and odors: The role of risk perception in asthma exacerbation. J. Psychosom. Res. 2014, 77, 302–308. [Google Scholar] [CrossRef] [Green Version]
  58. Luengas, A.; Barona, A.; Hort, C.; Gallastegui, G.; Platel, V.; Elias, A. A review of indoor air treatment technologies. Rev. Environ. Sci. Bio/Technol. 2015, 14, 499–522. [Google Scholar] [CrossRef]
  59. de Juniac, A.; Kreis, I.; Ibison, J.; Murray, V. Epidemiology of unintentional carbon monoxide fatalities in the UK. Int. J. Environ. Health Res. 2012, 22, 210–219. [Google Scholar] [CrossRef]
  60. Sarigiannis, D.A.; Karakitsios, S.P.; Gotti, A.; Liakos, I.L.; Katsoyiannis, A. Exposure to major volatile organic compounds and carbonyls in European indoor environments and associated health risk. Environ. Int. 2011, 37, 743–765. [Google Scholar] [CrossRef]
  61. Jordan, R.E.; Cheng, K.K.; Miller, M.R.; Adab, P. Passive smoking and chronic obstructive pulmonary disease: Cross-sectional analysis of data from the Health Survey for England. BMJ Open 2011, 1, e000153. [Google Scholar] [CrossRef] [Green Version]
  62. Blanc, P.D.; Eisner, M.D.; Katz, P.P.; Yen, I.H.; Archea, C.; Earnest, G.; Janson, S.; Masharani, U.B.; Quinlan, P.J.; Hammond, S.K.; et al. Impact of the home indoor environment on adult asthma and rhinitis. J. Occup. Environ. Med. 2005, 47, 362–372. [Google Scholar] [CrossRef]
  63. Rushton, L. Health impact of environmental tobacco smoke in the home. Rev. Environ. Health 2004, 19, 291–309. [Google Scholar] [CrossRef]
  64. Gawande, S.; Tiwari, R.R.; Narayanan, P.; Bhadri, A. Indoor Air Quality and Sick Building Syndrome: Are Green Buildings Better than Conventional Buildings? Indian J. Occup. Environ. Med. 2020, 24, 30–32. [Google Scholar]
  65. Martheswaran, T.; Shmunes, M.H.; Ronquillo, Y.C.; Moshirfar, M. The impact of vaping on ocular health: A literature review. Int. Ophthalmol. 2021, 41, 2925–2932. [Google Scholar] [CrossRef]
  66. Choi, W.; Lian, C.; Ying, L.; Kim, G.E.; You, I.C.; Park, S.H.; Yoon, K.C. Expression of Lipid Peroxidation Markers in the Tear Film and Ocular Surface of Patients with Non-Sjogren Syndrome: Potential Biomarkers for Dry Eye Disease. Curr. Eye Res. 2016, 41, 1143–1149. [Google Scholar] [CrossRef]
  67. Yang, Q.; Li, K.; Li, D.; Zhang, Y.; Liu, X.; Wu, K. Effects of fine particulate matter on the ocular surface: An in vitro and in vivo study. Biomed. Pharmacother. 2019, 117, 109177. [Google Scholar] [CrossRef]
  68. Bascom, R.; Kulle, T.; Kagey-Sobotka, A.; Proud, D. Upper respiratory tract environmental tobacco smoke sensitivity. Am. Rev. Respir. Dis. 1991, 143, 1304–1311. [Google Scholar] [CrossRef]
  69. Annesi-Maesano, I.; Oryszczyn, M.P.; Raherison, C.; Kopferschmitt, C.; Pauli, G.; Taytard, A.; Tunon de Lara, M.; Vervloet, D.; Charpin, D. Increased prevalence of asthma and allied diseases among active adolescent tobacco smokers after controlling for passive smoking exposure. A cause for concern? Clin. Exp. Allergy 2004, 34, 1017–1023. [Google Scholar] [CrossRef]
  70. Díaz, E.; Smith-Sivertsen, T.; Pope, D.; Lie, R.T.; Díaz, A.; McCracken, J.; Arana, B.; Smith, K.R.; Bruce, N. Eye discomfort, headache and back pain among Mayan Guatemalan women taking part in a randomised stove intervention trial. J. Epidemiol. Community Health 2007, 61, 74–79. [Google Scholar] [CrossRef] [Green Version]
  71. Vitoux, M.A.; Kessal, K.; Baudouin, C.; Laprévote, O.; Melik Parsadaniantz, S.; Achard, S.; Brignole-Baudouin, F. Formaldehyde Gas Exposure Increases Inflammation in an In Vitro Model of Dry Eye. Toxicol. Sci. 2018, 165, 108–117. [Google Scholar] [CrossRef] [Green Version]
  72. Gupta, S.; Fink, M.K.; Martin, L.M.; Sinha, P.R.; Rodier, J.T.; Sinha, N.R.; Hesemann, N.P.; Chaurasia, S.S.; Mohan, R.R. A rabbit model for evaluating ocular damage from acrolein toxicity in vivo. Ann. N. Y. Acad. Sci. 2020, 1480, 233–245. [Google Scholar] [CrossRef]
  73. Li, J.; Zhang, G.; Nian, S.; Lv, Y.; Shao, Y.; Qiao, N.; Liang, R.; Huang, L.; Luo, A. Dry eye induced by exposure to cigarette smoke pollution: An in vivo and in vitro study. Free. Radic. Biol. Med. 2020, 153, 187–201. [Google Scholar] [CrossRef]
  74. Lee, K.; Hong, S.; Seong, G.J.; Kim, C.Y. Cigarette Smoke Extract Causes Injury in Primary Retinal Ganglion Cells via Apoptosis and Autophagy. Curr. Eye Res. 2016, 41, 1367–1372. [Google Scholar] [CrossRef]
  75. Smith, C.A.; Vianna, J.R.; Chauhan, B.C. Assessing retinal ganglion cell damage. Eye 2017, 31, 209–217. [Google Scholar] [CrossRef] [Green Version]
  76. Lee, A.J.; Rochtchina, E.; Wang, J.J.; Healey, P.R.; Mitchell, P. Does smoking affect intraocular pressure? Findings from the Blue Mountains Eye Study. J. Glaucoma 2003, 12, 209–212. [Google Scholar] [CrossRef]
  77. Jain, V.; Jain, M.; Abdull, M.M.; Bastawrous, A. The association between cigarette smoking and primary open-angle glaucoma: A systematic review. Int. Ophthalmol. 2017, 37, 291–301. [Google Scholar] [CrossRef]
  78. Pérez-de-Arcelus, M.; Toledo, E.; Martínez-González, M.; Martín-Calvo, N.; Fernández-Montero, A.; Moreno-Montañés, J. Smoking and incidence of glaucoma: The SUN Cohort. Medicine 2017, 96, e5761. [Google Scholar] [CrossRef]
  79. Reports of the Surgeon General. In The Health Consequences of Smoking: A Report of the Surgeon General; Centers for Disease Control and Prevention (US): Atlanta, GA, USA, 2004.
  80. Nagata, M.; Kojima, M.; Sasaki, K. Effect of vitamin E eye drops on naphthalene-induced cataract in rats. J. Ocul. Pharmacol. Ther. 1999, 15, 345–350. [Google Scholar] [CrossRef]
  81. Xu, G.T.; Zigler, J.S., Jr.; Lou, M.F. The possible mechanism of naphthalene cataract in rat and its prevention by an aldose reductase inhibitor (ALO1576). Exp. Eye Res. 1992, 54, 63–72. [Google Scholar] [CrossRef]
  82. Schaumberg, D.A.; Mendes, F.; Balaram, M.; Dana, M.R.; Sparrow, D.; Hu, H. Accumulated lead exposure and risk of age-related cataract in men. JAMA 2004, 292, 2750–2754. [Google Scholar] [CrossRef] [Green Version]
  83. Nita, M.; Grzybowski, A. Smoking and Eye Pathologies. A Systemic Review. Part I. Anterior Eye Segment Pathologies. Curr. Pharm. Des. 2017, 23, 629–638. [Google Scholar]
  84. Fullerton, D.G.; Bruce, N.; Gordon, S.B. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans. R. Soc. Trop. Med. Hyg. 2008, 102, 843–851. [Google Scholar] [CrossRef] [Green Version]
  85. Saha, A.; Kulkarni, P.K.; Shah, A.; Patel, M.; Saiyed, H.N. Ocular morbidity and fuel use: An experience from India. Occup. Environ. Med. 2005, 62, 66–69. [Google Scholar] [CrossRef]
  86. Pokhrel, A.K.; Smith, K.R.; Khalakdina, A.; Deuja, A.; Bates, M.N. Case-control study of indoor cooking smoke exposure and cataract in Nepal and India. Int. J. Epidemiol. 2005, 34, 702–708. [Google Scholar] [CrossRef] [Green Version]
  87. González, M.M.; Solano, M.M.; Porco, T.C.; Oldenburg, C.E.; Acharya, N.R.; Lin, S.C.; Chan, M.F. Epidemiology of uveitis in a US population-based study. J. Ophthalmic Inflamm. Infect. 2018, 8, 6. [Google Scholar] [CrossRef] [Green Version]
  88. Yuen, B.G.; Tham, V.M.; Browne, E.N.; Weinrib, R.; Borkar, D.S.; Parker, J.V.; Uchida, A.; Vinoya, A.C.; Acharya, N.R. Association between Smoking and Uveitis: Results from the Pacific Ocular Inflammation Study. Ophthalmology 2015, 122, 1257–1261. [Google Scholar] [CrossRef] [Green Version]
  89. Lin, P.; Loh, A.R.; Margolis, T.P.; Acharya, N.R. Cigarette smoking as a risk factor for uveitis. Ophthalmology 2010, 117, 585–590. [Google Scholar] [CrossRef] [Green Version]
  90. Roesel, M.; Ruttig, A.; Schumacher, C.; Heinz, C.; Heiligenhaus, A. Smoking complicates the course of non-infectious uveitis. Graefe’s Arch. Clin. Exp. Ophthalmol. 2011, 249, 903–907. [Google Scholar] [CrossRef]
  91. Sarir, H.; Mortaz, E.; Karimi, K.; Kraneveld, A.D.; Rahman, I.; Caldenhoven, E.; Nijkamp, F.P.; Folkerts, G. Cigarette smoke regulates the expression of TLR4 and IL-8 production by human macrophages. J. Inflamm. 2009, 6, 12. [Google Scholar] [CrossRef] [Green Version]
  92. Gonçalves, R.B.; Coletta, R.D.; Silvério, K.G.; Benevides, L.; Casati, M.Z.; da Silva, J.S.; Nociti, F.H., Jr. Impact of smoking on inflammation: Overview of molecular mechanisms. Inflamm. Res. 2011, 60, 409–424. [Google Scholar] [CrossRef]
  93. Iho, S.; Tanaka, Y.; Takauji, R.; Kobayashi, C.; Muramatsu, I.; Iwasaki, H.; Nakamura, K.; Sasaki, Y.; Nakao, K.; Takahashi, T. Nicotine induces human neutrophils to produce IL-8 through the generation of peroxynitrite and subsequent activation of NF-kappaB. J. Leukoc. Biol. 2003, 74, 942–951. [Google Scholar] [CrossRef]
  94. Curnow, S.J.; Falciani, F.; Durrani, O.M.; Cheung, C.M.; Ross, E.J.; Wloka, K.; Rauz, S.; Wallace, G.R.; Salmon, M.; Murray, P.I. Multiplex bead immunoassay analysis of aqueous humor reveals distinct cytokine profiles in uveitis. Invest. Ophthalmol. Vis. Sci. 2005, 46, 4251–4259. [Google Scholar] [CrossRef] [PubMed]
  95. Valentincic, N.V.; de Groot-Mijnes, J.D.; Kraut, A.; Korosec, P.; Hawlina, M.; Rothova, A. Intraocular and serum cytokine profiles in patients with intermediate uveitis. Mol. Vis. 2011, 17, 2003–2010. [Google Scholar]
  96. Khera, T.K.; Copland, D.A.; Boldison, J.; Lait, P.J.; Szymkowski, D.E.; Dick, A.D.; Nicholson, L.B. Tumour necrosis factor-mediated macrophage activation in the target organ is critical for clinical manifestation of uveitis. Clin. Exp. Immunol. 2012, 168, 165–177. [Google Scholar] [CrossRef]
  97. Quintana, F.J.; Basso, A.S.; Iglesias, A.H.; Korn, T.; Farez, M.F.; Bettelli, E.; Caccamo, M.; Oukka, M.; Weiner, H.L. Control of T(reg) and T(H)17 cell differentiation by the aryl hydrocarbon receptor. Nature 2008, 453, 65–71. [Google Scholar] [CrossRef] [PubMed]
  98. Veldhoen, M.; Hirota, K.; Westendorf, A.M.; Buer, J.; Dumoutier, L.; Renauld, J.C.; Stockinger, B. The aryl hydrocarbon receptor links TH17-cell-mediated autoimmunity to environmental toxins. Nature 2008, 453, 106–109. [Google Scholar] [CrossRef] [PubMed]
  99. Torii, K.; Saito, C.; Furuhashi, T.; Nishioka, A.; Shintani, Y.; Kawashima, K.; Kato, H.; Morita, A. Tobacco smoke is related to Th17 generation with clinical implications for psoriasis patients. Exp. Dermatol. 2011, 20, 371–373. [Google Scholar] [CrossRef]
  100. Escobar, T.; Yu, C.R.; Muljo, S.A.; Egwuagu, C.E. STAT3 activates miR-155 in Th17 cells and acts in concert to promote experimental autoimmune uveitis. Investig. Ophthalmol. Vis. Sci. 2013, 54, 4017–4025. [Google Scholar] [CrossRef] [Green Version]
  101. Wang, R.X.; Yu, C.R.; Mahdi, R.M.; Egwuagu, C.E. Novel IL27p28/IL12p40 cytokine suppressed experimental autoimmune uveitis by inhibiting autoreactive Th1/Th17 cells and promoting expansion of regulatory T cells. J. Biol. Chem. 2012, 287, 36012–36021. [Google Scholar] [CrossRef] [Green Version]
  102. Jadidi-Niaragh, F.; Mirshafiey, A. Th17 cell, the new player of neuroinflammatory process in multiple sclerosis. Scand. J. Immunol. 2011, 74, 1–13. [Google Scholar] [CrossRef]
  103. van Hamburg, J.P.; Asmawidjaja, P.S.; Davelaar, N.; Mus, A.M.; Colin, E.M.; Hazes, J.M.; Dolhain, R.J.; Lubberts, E. Th17 cells, but not Th1 cells, from patients with early rheumatoid arthritis are potent inducers of matrix metalloproteinases and proinflammatory cytokines upon synovial fibroblast interaction, including autocrine interleukin-17A production. Arthritis Rheum. 2011, 63, 73–83. [Google Scholar] [CrossRef]
  104. Zhang, L.; Li, J.M.; Liu, X.G.; Ma, D.X.; Hu, N.W.; Li, Y.G.; Li, W.; Hu, Y.; Yu, S.; Qu, X.; et al. Elevated Th22 cells correlated with Th17 cells in patients with rheumatoid arthritis. J. Clin. Immunol. 2011, 31, 606–614. [Google Scholar] [CrossRef]
  105. Smith, W.; Assink, J.; Klein, R.; Mitchell, P.; Klaver, C.C.; Klein, B.E.; Hofman, A.; Jensen, S.; Wang, J.J.; de Jong, P.T. Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology 2001, 108, 697–704. [Google Scholar] [CrossRef]
  106. Khan, J.C.; Thurlby, D.A.; Shahid, H.; Clayton, D.G.; Yates, J.R.; Bradley, M.; Moore, A.T.; Bird, A.C. Smoking and age related macular degeneration: The number of pack years of cigarette smoking is a major determinant of risk for both geographic atrophy and choroidal neovascularisation. Br. J. Ophthalmol. 2006, 90, 75–80. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  107. Smith, W.; Mitchell, P.; Leeder, S.R. Smoking and age-related maculopathy. The Blue Mountains Eye Study. Arch. Ophthalmol. 1996, 114, 1518–1523. [Google Scholar] [CrossRef]
  108. Bai, Y.C.; Wang, C.Y.; Lin, C.L.; Lai, J.N.; Wei, J.C. Association Between Air Pollution and the Risk of Uveitis: A Nationwide, Population-Based Cohort Study. Front. Immunol. 2021, 12, 613893. [Google Scholar] [CrossRef] [PubMed]
  109. Pons, M.; Marin-Castano, M.E. Nicotine increases the VEGF/PEDF ratio in retinal pigment epithelium: A possible mechanism for CNV in passive smokers with AMD. Invest. Ophthalmol. Vis. Sci. 2011, 52, 3842–3853. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  110. Nita, M.; Grzybowski, A. Smoking and Eye Pathologies. A Systemic Review. Part II. Retina Diseases, Uveitis, Optic Neuropathies, Thyroid-Associated Orbitopathy. Curr. Pharm. Des. 2017, 23, 639–654. [Google Scholar]
  111. Govindaraju, V.K.; Bodas, M.; Vij, N. Cigarette smoke induced autophagy-impairment regulates AMD pathogenesis mechanisms in ARPE-19 cells. PLoS ONE 2017, 12, e0182420. [Google Scholar] [CrossRef] [Green Version]
Figure 1. The impact of air pollutants on eye diseases from outdoor and indoor sources.
Figure 1. The impact of air pollutants on eye diseases from outdoor and indoor sources.
Ijerph 19 01186 g001
Table 1. Eye-damaging air pollutants and their relevant studies on eye diseases.
Table 1. Eye-damaging air pollutants and their relevant studies on eye diseases.
Pollutant(s)Ocular Disorder(s)Study ModelReference
Outdoor pollutant(s)
COAMDPopulation-based study[21]
NOConjunctivitisData collection[22,23]
NO2AMDPopulation-based study[21]
ConjunctivitisData collection[24]
Nonspecific conjunctivitis[25]
NOxMyopiaData collection[26]
In vivo/hamster model
O3Nonspecific conjunctivitisData collection[25]
PM2.5DRNational cross-sectional study[27]
MyopiaData collection[26]
In vivo/hamster model
Nonspecific conjunctivitisData collection[25]
POAGNested case–control study[28]
Retinal layer thinningCommunity-based cohort study[29]
PM10Childhood glaucomaRetrospective cohort study[30]
Nonspecific conjunctivitisData collection[25]
Retinal layer thinningCommunity-based cohort study[29]
SO2Nonspecific conjunctivitisData collection[25]
Indoor pollutant(s)
AcroleinOSDIn vivo/rabbit model[31]
AldehydesTear film instability and lipid layer peroxidationTears from subjects[22,23]
CSEAMDIn vitro/ARPE-19 cells[32]
GlaucomaIn vitro/primary rat RGCs[33,34]
FormaldehydeOSDIn vitro/WKD cells[35]
NaphthaleneCataractsIn vivo/rat model[36,37]
NicotineOSDIn vitro/corneal epithelial cells[38]
UveitisSubjects’ and patients’ AqH[39,40,41,42]
PM2.5Dry eye syndromeIn vitro/HCE cells[43]
In vivo/mouse model
Tabaco smokingOSDIn vitro/HCE cells[44]
In vivo/mouse model
Rhino-conjunctivitisCross-sectional study[45]
Table 2. WHO 2021 air pollution guidelines in comparison with guidelines in 2005.
Table 2. WHO 2021 air pollution guidelines in comparison with guidelines in 2005.
Pollutant(s)Averaging TimeWHO 2021 Air Quality GuidelineWHO 2005 Air Quality GuidelineChange
PM2.5 (μg/m3)Annual510−50%
PM10 (μg/m3)Annual1520−25%
O3 (μg/m3)Peak season60N/ANewly introduced
NO2 (μg/m3)Annual1040−75%
24-h25N/ANewly introduced
SO2 (μg/m3)24-h4020+100%
CO (mg/m3)24-h4N/ANewly introduced
8-h10N/ANewly introduced
1-h35N/ANewly introduced
15-min100N/ANewly introduced
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Lin, C.-C.; Chiu, C.-C.; Lee, P.-Y.; Chen, K.-J.; He, C.-X.; Hsu, S.-K.; Cheng, K.-C. The Adverse Effects of Air Pollution on the Eye: A Review. Int. J. Environ. Res. Public Health 2022, 19, 1186.

AMA Style

Lin C-C, Chiu C-C, Lee P-Y, Chen K-J, He C-X, Hsu S-K, Cheng K-C. The Adverse Effects of Air Pollution on the Eye: A Review. International Journal of Environmental Research and Public Health. 2022; 19(3):1186.

Chicago/Turabian Style

Lin, Chia-Ching, Chien-Chih Chiu, Po-Yen Lee, Kuo-Jen Chen, Chen-Xi He, Sheng-Kai Hsu, and Kai-Chun Cheng. 2022. "The Adverse Effects of Air Pollution on the Eye: A Review" International Journal of Environmental Research and Public Health 19, no. 3: 1186.

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