The Impact of Home Interventions on Dry Eye Disease (DED) Symptoms and Signs in United States Veterans

Background: The indoor environment can contribute to dry eye disease (DED) risk, but the effects of environmental modifications on disease are still uncertain. This study evaluated the effect of home interventions that modify the indoor environment on DED symptoms and sign severity. Methods: The prospective study consisted of two visits (6 ± 1 months apart). At each home visit, indoor environmental conditions (temperature, humidity, and airborne particulate matter) were monitored and at each clinical visit, DED symptoms and signs were examined. After the first visit, all participants received a report of their home air quality and 10 recommendations to improve their home environment. At the 6-month visit, participants indicated which interventions they implemented. Results: A total of 99 subjects participated in the clinical evaluation and home monitoring at baseline and six-month follow-up. Their mean age was 61 years, and 26% identified as Hispanic. Most had mild or greater DED symptoms (5-Item Dry Eye Questionnaire, DEQ5 ≥ 6), with an average DEQ5 score of 10.49 ± 5.51 at baseline. In total, 77% (n = 76) implemented ≥1 intervention with home ventilation (42.4%), air conditioner filter change (36.4%), and exhaust fan use (31.3%) being the most frequent. Overall, with every intervention implemented, tear osmolarity (change from baseline to 6 months) declined by 2% (log-transformed β = 0.02; 95% confidence interval (CI) = 0.00–0.03; p < 0.05), and Meibomian gland (MG) plugging declined by 14% (log-transformed β = 0.14; CI = 0.05–24; p < 0.05). Specific interventions had specific impacts on DED signs and symptoms. For example, osmolarity declined by a greater degree in those that implemented home ventilation, while DED symptoms improved to a greater degree in those that utilized indoor plants compared to those that did not implement these interventions. Conclusions: When provided with an objective report of home environmental conditions and remediation strategies, most participants voluntarily implemented low-cost home interventions, which reduced the severity of select DED symptoms and signs.