BACKGROUND: The NHS has committed to achieving net-zero carbon emissions by 2045. Dry eye disease, a chronic condition affecting approximately 29.5% of the global population, poses a significant challenge due to its environmentally harmful care pathway, which also exacerbates the condition. This research article presents a multi-centre cross-sectional survey of patients with severe dry eye disease to examine the pollution and emissions associated with the NHS dry eye disease care pathway. The aim is to identify target areas where innovation can aid the NHS in reaching its net-zero goal. METHODS: Ninety-two patients participated in semi-structured interviews at four tertiary care centres in the United Kingdom. RESULTS: Medication packaging disposal was reported as follows: 36% of patients disposed of everything in household waste, 13% recycled everything, and 51% used a mixture of both. Only 7% of patients reported that medication packaging had clear recycling instructions, 23% reported no instructions, and 71% had not noticed. Patients attended a median of 3 (range
1, 15) hospital appointments per year, with 62% traveling by car and a median return journey time of 100 (8, 300) minutes. When asked if having dry eye disease significantly increased their carbon footprint, 32% agreed, 32% were unsure, and 37% disagreed. The predominant suggestion for reducing environmental harm was "environmentally friendly packaging." CONCLUSION: This research highlights the need for more sustainable packaging solutions, including clearer recycling instructions, and explores issues related to avoidable travel and insufficient education. By addressing these areas, the NHS can make significant progress towards achieving its net-zero emissions goal.