TFOS lifestyle: Impact of lifestyle challenges on the ocular surface

Anat Galor, Alexis Ceecee Britten-Jones, Yun Feng, Giulio Ferrari, David Goldblum, Preeya K Gupta, Jesus Merayo-Lloves, Kyung-Sun Na, Shehzad A Naroo, Kelly K Nichols, Eduardo M Rocha, Louis Tong, Michael T M Wang, Jennifer P Craig

Research output: Contribution to journalArticlepeer-review


Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to Meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.

Original languageEnglish
Pages (from-to)262-303
Number of pages42
JournalThe ocular surface
Early online date11 Apr 2023
Publication statusPublished - Apr 2023


  • Anxiety
  • Sleep disorders
  • Systematic review
  • Depression
  • Ocular surface disease
  • Social factors
  • Physical factors
  • Dry eye disease
  • Mental health
  • Chronic pain


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