Can we treat dry eyes without destroying our planet? a critical analysis of environmental sustainability in dry eye disease management.

PURPOSE: To analyze the environmental impact of dry eye disease management and identify evidence-based strategies for sustainable healthcare delivery in ophthalmology.

METHODS

This review synthesizes current literature examining environmental consequences of dry eye disease treatment protocols, waste generation patterns, patient transportation emissions, and emerging sustainable solutions.

RESULTS

Single-dose delivery systems generate substantially higher plastic waste compared to multi-dose alternatives, with German data showing treatment waste increased from 7.13 to 20.64 tons between 2016 and 2021. Patients produce median annual plastic waste of 0.64 kg from single-dose dispensers versus 0.13 kg from multi-dose systems, while serum therapies generate up to 3 kg annually per patient. Transportation patterns contribute significantly to carbon emissions, with patients attending median 3 yearly appointments and 62% traveling by automobile. Energy-intensive cold storage requirements for specialized treatments further compound environmental impact. Epidemiological evidence reveals concerning connections between air pollution and dry eye disease occurrence, creating cyclical patterns of environmental damage and increased treatment needs.

CONCLUSION

Transitioning to multi-dose preservative-free packaging, biodegradable delivery materials, telemedicine-supported follow-up, optimized cold-chain management for biological therapies, and improved recycling infrastructure can substantially reduce the environmental footprint of dry eye disease care without compromising clinical efficacy. Clinical implementation should be risk-stratified, as remote assessment remains constrained by dry eye disease's reliance on slit-lamp-based clinical signs, and further health economic and life-cycle assessment data are needed to guide policy and practice. Enhanced patient education and regulatory frameworks prioritizing sustainability remain essential for a successful transition toward carbon-neutral dry eye disease care.