PURPOSE: To evaluate the association between green space exposure and dry eye. DESIGN: Part I: case-control study. Part II: cross-sectional study. METHODS: Part I: The study contained 450 patients with dry eye and 900 controls recruited from Electronic Health Records. Logistic regression analysis was employed to investigate the relationship between green space exposure and the occurrence of dry eye. Part II: This study included 140 diabetic participants recruited from the community registry in Guangzhou, China. Linear regression analysis was used to assess the association between green space exposure and quantitative measures of the tear meniscus. RESULTS: Part I: A total of 1350 individuals were included in the study. On average individuals aged 31.07 ± 4.58 years and 59.33 % were female. Higher 10-year green space exposure was significantly associated with lower odds of dry eye (OR = 0.96
95 % confidence interval [CI], 0.94, 0.97
p <
0.001) after adjusting for age, sex, rainfall, temperature, particulate matter, and other factors. Part II: A total of 140 diabetic patients were included in the study. On average individuals aged 64.48 ± 8.19 years and 53.57 % were female. Greater 10-year green space exposure was associated with a higher tear meniscus area (β = 0.07, 95 % CI, 0.02, 0.11
p = 0.007) after adjusting for age, sex, rainfall, temperature, particulate matter, and other factors. CONCLUSIONS: Our findings suggest an association between green space exposure and diagnosis of dry eye and tear meniscus, offering novel insights into the strategies for preventing dry eye.