J Korean Med Assoc Search


J Korean Med Assoc > Volume 62(9); 2019 > Article
Choi, Eom, Song, and Kim: Fine dust and eye health


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.

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
PM2.5 0-15 16-30 36-75 ≥76

PM10, particulate matter less than 10 µm in diameter; PM2.5, 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
PM2.5 Issue When an hourly average PM2.5 concentration of more than 75 μg/m3 When an hourly average PM2.5 concentration of more than 150 μg/m3
    continues for more than 2 hours continues for more than 2 hours
  Clear When an hourly average PM2.5 concentration is less than 35 μg/m3 When an hourly average PM2.5 concentration is less than 75 μg/m3

PM10, particulate matter less than 10 µm in diameter; PM2.5, 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


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.
crossref pmid pmc
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.
crossref pmid pmc
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid pmc
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.
crossref pmid
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.
crossref pmid pmc pdf
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid pmc
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid
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.
crossref pmid pmc
27. Dartt DA. Control of mucin production by ocular surface epithelial cells. Exp Eye Res 2004;78:173-185.
crossref pmid
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.
crossref pmid
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.
crossref pmid
30. Jung SJ, Mehta JS, Tong L. Effects of environment pollution on the ocular surface. Ocul Surf 2018;16:198-205.
crossref pmid
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.
crossref pmid
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.
crossref pmid
33. Wolkoff P. Ocular discomfort by environmental and personal risk factors altering the precorneal tear film. Toxicol Lett 2010;199:203-212.
crossref pmid
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.
pmid pmc
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.
crossref pdf
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.
crossref pmid
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.
crossref pmid pmc pdf
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.
crossref pmid pmc
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.
crossref pmid


Browse all articles >

Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next