Knowledge-Behavior and Adherence Gap in Protective Eyewear Use Among Outdoor Workers with High Ocular Surface Disease Burden in a Desert Environment.

OBJECTIVE

Outdoor workers' ocular health in harsh environments is often overlooked, despite their heightened risk of eye disease. This study aimed to examine knowledge of sun-related ocular hazards and adherence to protective eyewear use among outdoor workers in a desert environment, and to contextualize these behaviors against objective ocular surface findings.

METHODS

A cross-sectional study was conducted among 133 male outdoor workers engaged in cultivation, cleaning, maintenance, and construction at Qassim University, Saudi Arabia, a region characterized by intense solar ultraviolet radiation, high ambient temperatures, low relative humidity, and frequent dust storms. Participants underwent comprehensive ocular surface evaluation, including slit-lamp biomicroscopy and objective tear film assessment using the Keratograph 5M. Knowledge of UV-related ocular hazards was assessed using items adapted from a validated UV knowledge instrument, and self-reported protective eyewear adherence during outdoor work was recorded.

RESULTS

Protective eyewear adherence was low: 59.4% of workers reported never using eye protection during outdoor work, while only 8.3% reported consistent use. Lower knowledge of sun-related ocular health risks was observed in 63.2% of participants. Objective clinical signs consistent with dry eye disease were observed in 54.1%, and pinguecula was observed in 45.9%. Knowledge level and protective eyewear use were not significantly associated with DED or pinguecula.

CONCLUSION

These findings show a clear gap between what workers know about eye protection and how often they actually use it. The combination of low protective eyewear use and a high observed burden of ocular surface disease suggests that education alone may not be enough. Although workplace factors were not directly measured, workplace-level support, easier access to suitable protective eyewear, and practical eye-health education tailored to workers' needs represent plausible, testable directions for improving protection in desert outdoor work settings.