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Eye Irritation

Eye irritation has been defined as “the magnitude of any stinging, scratching, burning, or other irritating sensation from the eye”.[5] It is a common problem experienced by people of all ages. Related eye symptoms and signs of irritation are e.g. discomfort, dryness, excess tearing, itching, grating, sandy sensation, smarting, ocular fatigue, pain, scratchiness, soreness, redness, swollen eyelids, and tiredness, etc. These eye symptoms are reported with intensities from severe to less severe. It has been suggested that these eye symptoms are related to different causal mechanisms.[6]

Several suspected causal factors in our environment have been studied so far.[7] One hypothesis is that indoor air pollution may cause eye and airway irritation.[8][9] Eye irritation depends somewhat on destabilization of the outer-eye tear film, in which the formation of dry spots results in such ocular discomfort as dryness.[8][10][11] Occupational factors are also likely to influence the perception of eye irritation. Some of these are lighting (glare and poor contrast), gaze position, a limited number of breaks, and a constant function of accommodation, musculoskeletal burden, and impairment of the visual nervous system.[12][13] Another factor that may be related is work stress.[14][15] In addition, psychological factors have been found in multivariate analyses to be associated with an increase in eye irritation among VDU users.[16][17] Other risk factors, such as chemical toxins/irritants, e.g. amines, formaldehyde, acetaldehyde, acrolein, N-decane, VOCs; ozone, pesticides and preservatives, allergens, etc. might cause eye irritation as well.

Certain volatile organic compounds that are both chemically reactive and airway irritants may cause eye irritation as well. Personal factors (e.g., use of contact lenses, eye make-up, and certain medications) may also affect destabilization of the tear film and possibly result in more eye symptoms.[6] Nevertheless, if airborne particles alone should destabilize the tear film and cause eye irritation, their content of surface-active compounds must be high.[6] An integrated physiological risk model with blink frequency, destabilization, and break-up of the eye tear film as inseparable phenomena may explain eye irritation among office workers in terms of occupational, climate, and eye-related physiological risk factors.[6]

There are two major measures of eye irritation. One is blink frequency which can be observed by human behavior. The other measures are break up time, tear flow, hyperemia (redness, swelling), tear fluid cytology, and epithelial damage (vital stains) etc., which are human beings’ physiological reactions. Blink frequency is defined as the number of blinks per minute and it is associated with eye irritation. Blink frequencies are individual with mean frequencies of < 2-3 to 20-30 blinks/minute, and they depend on environmental factors including the use of contact lenses. Dehydration, mental activities, work conditions, room temperature, relative humidity, and illumination all influence blink frequency. Break-up time (BUT) is another major measure of eye irritation and tear film stability.[18] It is defined as the time interval (in seconds) between blinking and rupture. BUT is considered to reflect the stability of the tear film as well. In normal persons, the break-up time exceeds the interval between blinks, and, therefore, the tear film is maintained.[19] Studies have shown that blink frequency is correlated negatively with break-up time. This phenomenon indicates that perceived eye irritation is associated with an increase in blink frequency since the cornea and conjunctiva both have sensitive nerve endings that belong to the first trigeminal branch.[20][21] Other evaluating methods, such as hyperemia, cytology etc. have increasingly been used to assess eye irritation.

There are other factors that related to eye irritation as well. Three major factors that influence the most are indoor air pollution, contact lenses and gender differences. Field studies have found that the prevalence of objective eye signs is often significantly altered among office workers in comparisons with random samples of the general population.[22][23][24][25] These research results might indicate that indoor air pollution has played an important role in causing eye irritation. There are more and more people wearing contact lens now and dry eyes appear to be the most common complaint among contact lens wearers.[26][27][28] Although both contact lens wearers and spectacle wearers experience similar eye irritation symptoms, dryness, redness, and grittiness have been reported far more frequently among contact lens wearers and with greater severity than among spectacle wearers.[28] Studies have shown that incidence of dry eyes increases with age.[29][30] especially among women.[31] Tear film stability (e.g. break-up time) is significantly lower among women than among men. In addition, women have a higher blink frequency while reading.[32] Several factors may contribute to gender differences. One is the use of eye make-up. Another reason could be that the women in the reported studies have done more VDU work than the men, including lower grade work. A third often-quoted explanation is related to the age-dependent decrease of tear secretion, particularly among women after 40 years of age.,[33][34][35]

In a study conducted by UCLA, the frequency of reported symptoms in industrial buildings was investigated.[36] The study’s results were that eye irritation was the most frequent symptom in industrial building spaces, at 81%. Modern office work with use of office equipment has raised concerns about possible adverse health effects.[37] Since the 1970s, reports have linked mucosal, skin, and general symptoms to work with self-copying paper. Emission of various particulate and volatile substances has been suggested as specific causes. These symptoms have been related to Sick Building Syndrome (SBS), which involves symptoms such as irritation to the eyes, skin, and upper airways, headache and fatigue.[38]

Many of the symptoms described in SBS and multiple chemical sensitivity (MCS) resemble the symptoms known to be elicited by airborne irritant chemicals.[39] A repeated measurement design was employed in the study of acute symptoms of eye and respiratory tract irritation resulting from occupational exposure to sodium borate dusts.[40] The symptom assessment of the 79 exposed and 27 unexposed subjects comprised interviews before the shift began and then at regular hourly intervals for the next six hours of the shift, four days in a row.[40] Exposures were monitored concurrently with a personal real time aerosol monitor. Two different exposure profiles, a daily average and short term (15 minute) average, were used in the analysis. Exposure-response relations were evaluated by linking incidence rates for each symptom with categories of exposure.[40]

Acute incidence rates for nasal, eye, and throat irritation, and coughing and breathlessness were found to be associated with increased exposure levels of both exposure indices. Steeper exposure-response slopes were seen when short term exposure concentrations were used. Results from multivariate logistic regression analysis suggest that current smokers tended to be less sensitive to the exposure to airborne sodium borate dust.[40]

Several actions can be taken to prevent eye irritation—

  • trying to maintain normal blinking by avoiding room temperatures that are too high; avoiding relative humidities that are too high or too low, because they reduce blink frequency or may increase water evaporation[6]
  • trying to maintain an intact tear film by the following actions. 1) blinking and short breaks may be beneficial for VDU users.[41][42] Increase these two actions might help maintain the tear film. 2) downward gazing is recommended to reduce the ocular surface area and water evaporation.[43][44][45] 3) the distance between the VDU and keyboard should be kept as short as possible to minimize evaporation from the ocular surface area by a low direction of the gaze.[46] And 4) blink training can be beneficial.[47]

In addition, other measures are proper lid hygiene, avoidance of eye rubbing,[48] and proper use of personal products and medication. Eye make-up should be used with care.[49]

February 26, 2012 The Eye
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