Fine dust and eye health

Soo Youn Choi; Youngsub Eom; Jong Suk Song; Hyo Myung Kim

doi:10.5124/jkma.2019.62.9.486

Journal List > J Korean Med Assoc > v.62(9) > 1133114

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Eom, Song, and Kim: Fine dust and eye health

Continuing Education Column

J Korean Med Assoc 2019;62(9):486-494.

Published online: 17 September 2019

DOI: https://doi.org/10.5124/jkma.2019.62.9.486

Fine dust and eye health

Soo Youn Choi, MD, Youngsub Eom, MD, Jong Suk Song, MD, Hyo Myung Kim, MD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Corresponding author: Youngsub Eom E-mail: eomy@korea.ac.kr

Received 13 August 2019 Accepted 10 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This paper aims to make recommendations for the management of eye health related to fine dust exposure. Fine dust is one of the biggest problems related to air pollution in Korea and is becoming a social issue. Fine dust can be classified into fine dust, ultrafine dust, and nanoparticles according to the size of the constituent particles. Although studies evaluating the harmful effects of particulate matter (PM) have been conducted mainly on cardiovascular and respiratory diseases, the ocular surface is a tissue that is continuously exposed to the atmosphere. Eye symptoms caused by PM exposure include eye redness, irritation, and sensation of a foreign body. Typical eye diseases caused by PM exposure include conjunctivitis, dry eye disease, and blepharitis. PM is thought to induce and exacerbate ocular surface diseases and lead to damage through oxidative stress, toxicity, and immune and inflammatory reactions on the ocular surface. For eye health management related to PM exposure, it is necessary to reduce the chance of exposure to PM in advance according to the PM forecast, avoid additional repeated exposure after PM exposure, and remove PM through eye washing and eyelid cleaning. In addition, eye drops, such as artificial tears, diquafosol, and cyclosporin A, can be used to prevent and treat ocular surface disease and deterioration of the damage. In patients who already have ocular surface disease, the harmful effects of PM exposure may be greater and more attention should be paid to eye health management.

Keywords: Air pollution, Environment, Dust, Eye, Health

REFERENCES

1. Brunekreef B, Beelen R, Hoek G, Schouten L, Bausch-Goldbohm S, Fischer P, Armstrong B, Hughes E, Jerrett M, van den Brandt P. Effects of longterm exposure to traffic-related air pollution on respiratory and cardiovascular mortality in the Netherlands: the NLCS-AIR study. Res Rep Health Eff Inst. 2009; 139:5–71.

2. Bayer-Oglesby L, Grize L, Gassner M, Takken-Sahli K, Sennhauser FH, Neu U, Schindler C, Braun-Fahrlander C. Decline of ambient air pollution levels and improved respiratory health in Swiss children. Environ Health Perspect. 2005; 113:1632–1637.

3. World Health Organization. Global Health Observatory (GHO) data [Internet]. Geneva: World Health Organization [cited 2019 May 10]. Available from:. https://www.who.int/gho/phe/outdoor_air_pollution/en/.

4. Thurston GD, Ito K, Mar T, Christensen WF, Eatough DJ, Henry RC, Kim E, Laden F, Lall R, Larson TV, Liu H, Neas L, Pinto J, Stolzel M, Suh H, Hopke PK. Workgroup report: workshop on source apportionment of particulate matter health effects: intercomparison of results and implications. Environ Health Perspect. 2005; 113:1768–1774.

5. Sun Y, Zhuang G, Wang Y, Han L, Guo J, Dan M, Zhang W, Wang Z, Hao Z. The airborne particulate pollution in Beijing: concentration, composition, distribution and sources. Atmos Environ. 2004; 38:5991–6004.

6. World Health Organization. WHO air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide: global update 2005. Summary of risk assessment. Geneva: World Health Organization;2006.

7. Brook RD, Rajagopalan S, Pope CA 3rd, Brook JR, Bhatnagar A, Diez-Roux AV, Holguin F, Hong Y, Luepker RV, Mittleman MA, Peters A, Siscovick D, Smith SC Jr, Whitsel L, Kaufman JD. American Heart Association Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Council on Nutrition, Physical Activity and Metabolism. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010; 121:2331–2378.

8. Atkinson RW, Anderson HR, Sunyer J, Ayres J, Baccini M, Vonk JM, Boumghar A, Forastiere F, Forsberg B, Touloumi G, Schwartz J, Katsouyanni K. Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. Am J Respir Crit Care Med. 2001; 164(10 Pt 1):1860–1866.

9. Valavanidis A, Fiotakis K, Vlachogianni T. Airborne particulate matter and human health: toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2008; 26:339–362.

10. Schwartz J, Neas LM. Fine particles are more strongly associated than coarse particles with acute respiratory health effects in schoolchildren. Epidemiology. 2000; 11:6–10.

11. Staniswalis JG, Yang H, Li WW, Kelly KE. Using a continuous time lag to determine the associations between ambient PM2.5 hourly levels and daily mortality. J Air Waste Manag Assoc. 2009; 59:1173–1185.

12. Klopfer J. Effects of environmental air pollution on the eye. J Am Optom Assoc. 1989; 60:773–778.

13. Li J, Tan G, Ding X, Wang Y, Wu A, Yang Q, Ye L, Shao Y. A mouse dry eye model induced by topical administration of the air pollutant particulate matter 10. Biomed Pharmacother. 2017; 96:524–534.

14. Tan G, Li J, Yang Q, Wu A, Qu DY, 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.

15. Tang YJ, Chang HH, Chiang CY, Lai CY, Hsu MY, Wang KR, Han HH, Chen LY, Lin DP. A murine model of acute allergic conjunctivitis induced by continuous exposure to particulate matter 2.5. Invest Ophthalmol Vis Sci. 2019; 60:2118–2126.

16. Chang CJ, Yang HH, Chang CA, Tsai HY. Relationship between air pollution and outpatient visits for nonspecific conjunctivitis. Invest Ophthalmol Vis Sci. 2012; 53:429–433.

17. Bourcier T, Viboud C, Cohen JC, 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.

18. 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.

19. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, Gupta PK, Karpecki P, Lazreg S, Pult H, Sullivan BD, Tomlinson A, Tong L, Villani E, Yoon KC, Jones L, Craig JP. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017; 15:539–574.

20. Hwang SH, Choi YH, Paik HJ, Wee WR, Kim MK, Kim DH. Potential importance of ozone in the association between outdoor air pollution and dry eye disease in South Korea. JAMA Ophthalmol. 2016; 134:503–510.

21. Galor A, Kumar N, Feuer W, Lee DJ. Environmental factors affect the risk of dry eye syndrome in a United States veteran population. Ophthalmology. 2014; 121:972–973.

22. Torricelli AA, Novaes P, Matsuda M, Braga A, Saldiva PH, Alves MR, Monteiro ML. Correlation between signs and symptoms of ocular surface dysfunction and tear osmolarity with ambient levels of air pollution in a large metropolitan area. Cornea. 2013; 32:e11–e15.

23. Novaes HM, Gouveia N, de Medeiros AP. Perinatal mortality and traffic-related air pollution. Rev Bras Ginecol Obstet. 2010; 32:471–475.

24. Malerbi FK, Martins LC, Saldiva PH, Braga AL. Ambient levels of air pollution induce clinical worsening of blepharitis. Environ Res. 2012; 112:199–203.

25. Eom Y, Song JS, Lee DY, Kim MK, Kang BR, Heo JH, Lee HK, Kim HM. Effect of titanium dioxide nanoparticle exposure on the ocular surface: an animal study. Ocul Surf. 2016; 14:224–232.

26. Novaes P, do Nascimento Saldiva PH, Kara-Jose N, Mac-chione 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.

27. Dartt DA. Control of mucin production by ocular surface epithelial cells. Exp Eye Res. 2004; 78:173–185.

28. Andres S, Garcia ML, Espina M, Valero J, Valls O. Tear pH, air pollution, and contact lenses. Am J Optom Physiol Opt. 1988; 65:627–631.

29. Squadrito GL, Cueto R, Dellinger B, Pryor WA. Quinoid redox cycling as a mechanism for sustained free radical generation by inhaled airborne particulate matter. Free Radic Biol Med. 2001; 31:1132–1138.

30. Jung SJ, Mehta JS, Tong L. Effects of environment pollution on the ocular surface. Ocul Surf. 2018; 16:198–205.

31. Corrales RM, Luo L, Chang EY, Pflugfelder SC. Effects of osmoprotectants on hyperosmolar stress in cultured human corneal epithelial cells. Cornea. 2008; 27:574–579.

32. Torricelli AA, Matsuda M, Novaes P, Braga AL, Saldiva PH, Alves MR, Monteiro ML. 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. Environ Res. 2014; 131:59–63.

33. Wolkoff P. Ocular discomfort by environmental and personal risk factors altering the precorneal tear film. Toxicol Lett. 2010; 199:203–212.

34. Patil NA, Gade WN, Deobagkar DD. Epigenetic modulation upon exposure of lung fibroblasts to TiO2 and ZnO nanoparticles: alterations in DNA methylation. Int J Nanomedicine. 2016; 11:4509–4519.

35. Kang SY, Kang B, Kim HM, Song JS. Effect of particulate matter on the NLRP3 inflammasomes in ocular tissues and cervical lymph nodes. J Korean Ophthalmol Soc. 2018; 59:130–136.

36. Key JE. A comparative study of eyelid cleaning regimens in chronic blepharitis. CLAO J. 1996; 22:209–212.

37. Li X, Kang B, Eom Y, Lee HK, Kim HM, Song JS. The protective effect of a topical mucin secretagogue on ocular surface damage induced by airborne carbon black exposure. Invest Ophthalmol Vis Sci. 2019; 60:255–264.

38. Lee H, Kim CE, Ahn BN, Yang J. Anti-inflammatory effect of hydroxyproline-GQDGLAGPK in desiccation stress-induced experimental dry eye mouse. Sci Rep. 2017; 7:7413.

39. Epitropoulos AT, Donnenfeld ED, Shah ZA, Holland EJ, Gross M, Faulkner WJ, Matossian C, Lane SS, Toyos M, Bucci FA Jr, Perry HD. Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes. Cornea. 2016; 35:1185–1191.

40. Han JY, Kang B, Eom Y, Kim HM, Song JS. Comparing the effects of particulate matter on the ocular surfaces of normal eyes and a dry eye rat model. Cornea. 2017; 36:605–610.

Figure 1.

Layers of the tear film.

Table 1.

Forecasts depending on the level of fine dust concentration

Concentration of fine dust (μg/m ³ · day)	Good	Normal	Bad	Very bad
PM¹⁰	0-30	31-80	81-150	≥151
PM^2.5	0-15	16-30	36-75	≥76

PM¹⁰, particulate matter less than 10 µm in diameter; PM^2.5, particulate matter less than 2.5 µm in diameter.

Table 2.

Watch/warning messages depending on the level of fine dust concentration

Cate	egory	Watch	Warning
PM¹⁰	Issue	When an hourly average PM¹⁰ concentration of more than 150 μg/m³	When an hourly average PM¹⁰ concentration of more than 300 μg/m³
		continues for more than 2 hours	continues for more than 2 hours
	Clear	When an hourly average PM¹⁰ concentration is less than 100 μg/m³	When an hourly average PM¹⁰ concentration is less than 150 μg/m³
PM^2.5	Issue	When an hourly average PM^2.5 concentration of more than 75 μg/m³	When an hourly average PM^2.5 concentration of more than 150 μg/m³
		continues for more than 2 hours	continues for more than 2 hours
	Clear	When an hourly average PM^2.5 concentration is less than 35 μg/m³	When an hourly average PM^2.5 concentration is less than 75 μg/m³

PM¹⁰, particulate matter less than 10 µm in diameter; PM^2.5, particulate matter less than 2.5 µm in diameter.

Table 3.

Seven action plans on high concentration fine dust

Action plans to protect health from fine dust exposure
Avoid going out as much as possible
Minimizing outdoor activities such as outdoor gatherings, camping, and sports
Wear a health mask (KFDA certification) when going out
Avoid places with heavy air pollution when going out and reduce activity
Reduce stay time on roadsides and construction sites with high concentration of fine dust
Reduce intense external activity that may cause inhalation of fine dust by increases breathing volume
Clean after going out
Wash your body in every corner, especially your hands, feet, eyes and nose in running water
Brush your teath
Eat fruits and vegetables rich in water and vitamin C
Drink plenty of water, antioxidants, fruits and vegetables
Manage indoor air quality such as ventilation and indoor water cleaning
Properly ventilate considering indoor and outdoor air pollution
Perform water cleaning such as wiping indoors, operate the air purifier, periodically check and replace the air purifier filter
Suppress air pollution inducement
Use public transportation instead of driving a car and suppress the act of burning waste
KFDA, Korea Food and Drug Administration.

Table 4.

Fine dust and eye health care

Action plans to protect eye heath from fine dust exposure
Reduce the chance of exposure to high concentration of fine dust in advance according to fine dust forecast system
Avoid repeated exposures when exposed to high levels of fine dust
Wash eyes with artificial tears and clean eyelids when exposed to high-concentration fine dust
Use eye drops to manage eye health (artificial tears, diquafosol, and cyclosporine)
Eat antioxidants, fruits, vegetables and omega-3s
Pay more attention to fine dust exposure and eye health care if you have ocualar surface disease

TOOLS

Similar articles