Climate-Related Environmental Exposures and Ocular Surface Disorders: A Systematic Review

Abla Yousif Mohamed ¹, Antoine Lefevre ², Léa Fontaine ² , Asim Ahmed³

Abstract

Background: The ocular surface is constantly exposed to environmental stressors. Climate related factors such as temperature, humidity, ultraviolet radiation, air pollution, dust storms, wildfire smoke, altitude, and extreme weather can disrupt tear film stability and contribute to ocular surface disease. Although previous reviews have examined broader ocular effects of climate change, few have focused specifically on the ocular surface. Objective: To systematically review evidence on the association between climate related environmental exposures and ocular surface disorders, including dry eye disease, conjunctivitis, keratitis, and pterygium, and to summarize mechanisms, vulnerable groups, and adaptation strategies. Methods: PubMed, Web of Science, and Google Scholar were searched for studies published up to March 2026. Eligible studies included observational, experimental human exposure, and mechanistic designs assessing temperature, humidity, UV exposure, air pollutants, dust storms, wildfire smoke, altitude, or extreme weather in relation to ocular surface outcomes. Results: Thirty eight studies were included. Low humidity and low temperature were consistently associated with worsening dry eye symptoms and signs. Air pollutants, especially particulate matter, nitrogen dioxide, and ozone, were linked to increased outpatient visits for dry eye and conjunctivitis. Wildfire smoke caused acute ocular surface inflammation. Dust storms and wind increased conjunctivitis risk. Higher temperature and UV exposure were associated with pterygium, while high altitude was linked to markedly higher prevalence. Keratitis showed seasonal variation. Conclusions: Climate related exposures significantly affect ocular surface health. Protective measures and further longitudinal research are needed to reduce climate related ocular morbidity.