Dry eye disease can compromise the patient’s quality of life. Few studies assessed the ocular surface (OS) in Ankylosing Spondylitis (AS) patients. This study aimed to evaluate the clinical and cytological findings of the OS in patients with AS, classify dry eye disease (DED) severity grade and conjunctival impression cytology (IC), and the effects of TNF inhibitors (TNFi) in a one-year follow-up. A baseline (BL) evaluation included 36 AS patients and 39 healthy controls. They fulfilled the Ocular Surface Index Disease questionnaire and underwent the Schirmer I test, break-up time, vital staining, and conjunctival IC. A DED severity grade, as well as IC rating, was applied. Fourteen of these patients received TNFi and analysis of ocular and systemic AS disease parameters occurred at BL and three months (3 M), and 12 months (12 M) after treatment. The AS patients presented a higher frequency of DED (p = 0.01), a worse score of severity (p = 0.001), and a higher frequency of altered IC (p = 0.007) when compared to controls. The 14 patients under TNFi presented an improvement in all the clinical disease activity parameters throughout the one-year treatment (p < 0.05) even as a concomitant increase in the Schirmer test (p = 0.04), and a significant amelioration in the altered IC to a normal IC (p = 0.006). DED is a frequent and under-diagnosed ocular disease in AS patients. The long-term parallel improvement of disease activity and OS parameters in AS patients receiving TNFi suggests that the OS can be an additional target of systemic inflammation in AS.

Dry eye disease (DED) is common in Rheumatoid Arthritis (RA) patients. The application of conjunctival goblet cell count as a clinical biomarker to diagnose and respond to treatment can take place in rheumatoid arthritis patients under TNF-inhibitors (TNFi) therapy. This study aimed to investigate the ocular surface parameters and the long-term effects of TNFi therapy on ocular surface features and goblet cell count of rheumatoid arthritis patients. At baseline, rheumatoid arthritis patients eligible to TNFi were compared to healthy controls (similar age/gender), regarding Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear break-up time test, vital dye staining of the ocular surface, and conjunctival impression cytology. DED severity grade, impression cytology score, and goblet cell count were analyzed. Rheumatoid arthritis patients were followed after three (3 M) and 12 months (12 M), during TNFi treatment. Sixteen rheumatoid arthritis patients and 24 controls were compared: a higher frequency of abnormal OSDI (68.8% vs. 16.7%, p = 0.002), Schirmer’s test < 10 mm (37.5% vs. 8.3%, p = 0.042), meibomian gland dysfunction (50% vs. 8.3%, p = 0.007), abnormal impression cytology (75% vs. 8.3%, p < 0.001), and mild to moderate DED (81.3% vs. 4.2%, p < 0.001) were observed in rheumatoid arthritis patients, who also had lower goblet cell count [325 (274–707) cells/mm2 vs. 742 (562–863) cells/mm2, p = 0.004]. The presence of Meibomian gland dysfunction was associated with higher disease activity scores (p < 0.05). The prospective early observation of these patients at 3 M showed an increase improvement in tear production by Schirmer’s test [13 (7.5–17.5) vs. 23.5 (16–35); p = 0.001], and an improvement in impression cytology score [1 (0.5–2) vs. 1 (0–1), p = 0.031] and in goblet cell count [325 (274–707) vs. 931 (656–1,244), p < 0.001]. Eight RA responders to TNFi were also re-evaluated at 12 M with further improvement in goblet cell count [393 (275–827) vs. 872 (502–1,185) vs. 1,079 (867–1,244), p = 0.047]. Multifactorial DED is frequent in RA patients, comprising aqueous, lipid, and mucin components. TNFi prompt improves tear production and recovers the goblet cells, which can be a biomarker of the pathological process and response to therapy in this population.

Antioxidants protect cells from the injuries caused by oxidative reactive species, especially under biotic and abiotic stressful conditions. Each kind of free radical presents different oxidative sites and, therefore, different assays could be done to better evaluate the antioxidant capacity of a compound. Little is known about secondary metabolites from Annona coriacea Mart. (Annonaceae), especially related to their antioxidant capacity. Eleven flavonols were isolated from leaves: Quercetin-3-O-gentiobioside (1), Quercetin-3-O-robinobioside (2), Rutin (3), Hyperin (4), Isoquercitrin (5), Biorobin (6), Nicotiflorin (7), Keioside (8), Narcissin (9), Cacticin (10) and Isorhamnetin-3-O-glucoside (11). The isolated compounds and their commercial aglycones were evaluated in DPPH, ABTS+• radical scavenging, ferric reducing antioxidant power (FRAP) and oxygen reduction antioxidant capacity (ORAC). Two patterns of response were observed. In the first, found in DPPH and FRAP assays, quercetin and its derivatives (1–5) showed higher antioxidant activity than kaempferol (6–7) and isorhamnetin derivatives (8–11). On the other hand, in the second pattern, observed in ABTS+• and ORAC assays, isorhamnetin showed higher or similar activities than quercetin derivatives. These differences were attributed to the B-ring substitution pattern of flavonols and to the distinct mechanisms of antioxidant activity in each assay. Different assays must be performed to determine the mechanisms of antiradicalar action of a compound.

Descrever e analisar os principais pontos dos estudos sobre Avaliação de Impacto na Saúde (AIS) realizados na Austrália e obter contribuições para a implantação da AIS no Brasil. Foi realizada uma revisão bibliográfica extensa sobre os artigos publicados e indexados entre 1990 e 2014, nas bases de dados Pubmed, Web of Knowledge, Science Direct e Portal Periódicos da CAPES. Os textos completos dos artigos sobre AIS na Austrália foram classificados como analíticos ou estudos de caso (EC), e analisados. Do total de 37 artigos, 26 foram analíticos e 11 EC. Os principais aspectos teóricos da AIS como ferramenta e da sua aplicação na Austrália foram abordados, mostrando como e por que a atividade de AIS tem crescido em diversidade e profundidade. A maioria dos EC descrevem a aplicação prática da AIS na área de planejamento urbano e abordam seus benefícios e sua influência no processo de tomada de decisão. 91% das AIS foram prospectivas e 45% completas. No Brasil a prática da AIS é incipiente, mas existe movimentação política no sentido de integrá-la ao estudo de impacto ambiental, e de inserir questões de saúde no licenciamento ambiental de projetos. A experiência australiana mostra que a implantação da AIS é viável, e que sua incorporação influencia no processo de tomada de decisão.Palavras-Chave: Saúde ambiental. Impacto Ambiental. Avaliação em Saúde.AbstractTo describe and analyze the focal points of the studies about Health Impact Assessment conducted in Australia and obtain elements to aid in the implementation of HIA in Brazil. We conducted an extense literature review of articles about HIA in Australia, published and indexed in the period between 1990 and 2014, in Pubmed, Web of Knowledge, Science Direct e Portal Periódicos da CAPES. The complete texts were read and classified in analytical or case studies (CS), and then analyzed. Out of a total of 37 articles, 26 were analytical and 11 CS. The main theoretical aspects of HIA as a tool and its application in Australia were described, highlighting why and how HIA has been successful and has grown in diversity and depth in this setting. Most CS described the use of HIA in urban planning, its benefits and its influence in the decision-making process. 91% of the HIAs were prospective and 45% complete. The practice of HIA is incipient in Brazil, however there is political urge to integrate HIA to ElA, and to include health issues in the environmental licensing process. The australian experience is a successful example of the practical use of HIA and shows how it influences the decision-making process.Keywords: Health Impact Assessment. Environmental Health. Environmental Impact.

Purpose Orbital fibroblasts from patients with Graves' disease (GD-OF) express many different cytokines when treated with bovine thyrotropin (bTSH). The present study aimed to determine why TNF-α cannot be induced by bTSH in GD-OF. Methods Fibrocytes and GD-OFs were cultivated from donors who were patients in a busy academic medical center practice. Real-time PCR, Western blot analysis, reporter gene assays, cell transfections, mRNA stability assays, ELISA, and flow cytometry were performed. Results We found that bTSH induces TNF-α dramatically in fibrocytes but is undetectable in GD-OF. The induction in fibrocytes is a consequence of increased TNF-α gene promoter activity and is independent of ongoing protein synthesis. It could be attenuated by dexamethasone and the IGF-1 receptor inhibiting antibody, teprotumumab. When separated into pure CD34+ OF and CD34− OF subsets, TNF-α mRNA became highly inducible by bTSH in CD34+ OF but remained undetectable in CD34− OF. Conditioned medium from CD34− OF inhibited induction of TNF-α in fibrocytes. Conclusions Our data indicate that CD34− OF appear to release a soluble(s) factor that downregulates expression and induction by bTSH of TNF-α in fibrocytes and their derivative CD34+ OF. We proffer that CD34− OF produce an unidentified modulatory factor that attenuates TNF-α expression in GD-OF and may do so in the TAO orbit.

Atmospheric pollution arising from diesel-powered engines can result in acute and chronic diseases of the respiratory and cardiovascular systems. The annual carnival festival that takes place in the city of Salvador, Bahia-Brazil, is a large-scale event that gathers approximately 2 m revelers and 170,000 workers who accompany dozens of sound-trucks, or trios el&eacute;tricos, for a period of seven days. These slow-moving sound-trucks run on diesel fuel, constantly exposing those around them to exhaust fumes. The present study aimed to evaluate air quality along the approximately 10km-long carnival parade circuit and determine possible impacts on human health. We applied a three-phase risk analysis strategy from 2007&ndash;2009: 1) hazard identification, 2) risk characterization and 3) risk management. Our quantification of atmospheric particulate matter 2.5 (PM2.5) and nitrogen dioxide (NO2) concentrations revealed variable levels of PM2.5 ranging from 19 &micro;g/m3 to 580 &micro;g/m3, with peaks of up to 800 &mu;g/m3 at sound-truck concentration areas. We then assessed the effects of air pollution on human health using ophthalmologic parameters obtained from 28 carnival volunteers, who often presented symptoms of eye irritation. Finally, we established strategies to communicate the study&rsquo;s objectives and obtained results to the population through media outlets and open discussions with government agencies. According to our risk analysis, carnival sound-trucks represent the main source of atmospheric PM2.5 and NO2 pollution during the annual 7-day carnival festival. As a consequence of our research, the municipal government of Salvador issued an addendum to its carnival legislation mandating organizers to monitor atmospheric pollution, and, subsequently, all large-scale public events. Municipal government authorities have also promoted a shift from petroleum-based diesel fuel to biodiesel, a less-polluting fuel, for all adapted carnival sound-trucks. Our approach, which employed easily accessible and inexpensive methodology, provided substantial scientific evidence to support improvements in the regulation of air quality during large-scale public events held in the city of Salvador.Keywords: environmental

aOswaldo Cruz Foundation, FIOCRUZ, Salvador, BA, Brazil 6 bLaboratory of Atmospheric and Experimental Pollution, School of Medicine, University of São Paulo, São 7 Paulo, SP, Brazil 8 cSecretaria Municipal de Saúde de Salvador, Salvador, BA, Brazil 9 dFaculty of Dentistry, Federal University of Bahia; Faculty of Dentistry, State University of Feira de Santana, 10 BA, Brazil 11 eInstitute of Enviromental, Chemistry and Pharmaceutics Sciences (ICAQF), Federal University of São Paulo, 12 São Paulo, SP, Brazil. 13 fLaboratory of Biomineralization, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de 14 Janeiro, RJ, Brazil. 15 *Corresponding authors: NAV: Laboratory of Epidemiology and Biostatistics, Oswaldo Cruz Foundation, 16 Brazilian Ministry of Health. Av. Waldemar Falcão, 121, Candeal, Salvador, BA, Brazil, 40296-710 17 Email: nelzair.vianna@bahia.fiocruz.br 18 LRA: Av. Carlos Chagas Filho 373, room F2-30, ICB, CCS, UFRJ, Cidade Universitária, Rio de Janeiro, RJ, 19 Brazil, 21941-902 20 Email: andrade@histo.ufrj.br 21

Thyroid-associated ophthalmopathy (TAO) is a condition associated with a wide spectrum of ocular changes, usually in the context of the autoimmune syndrome, Graves' disease. In this topical review, we attempted to provide a roadmap of the recent advances in current understanding the pathogenesis of TAO, important aspects of its clinical presentation, its impact on the ocular surface, describe the tissue abnormalities frequently encountered, and describe how TAO is managed today. We also briefly review how increased understanding of the disease should culminate in improved therapies for patients with this vexing condition.

Introduction: Developing countries lack the technology to detect and measure levels of air pollution, making it difficult to update legislation on air quality standards for the control of emission sources, as well as to implement surveillance program. Several methodological approaches have been suggested by international agencies, however for the local context it is necessary to make adjustments that will result in replicable methods across Brazilian agencies. In Brazil, the Ministry of Health, through the Environmental Health Surveillance, stimulates the development of methodologies that can facilitate the implementation of a health surveillance program related to air quality. Objective: The objective of this study was to apply tools for risk analysis approach to evaluate the air quality of the city of Salvador and its impact on health, from the perspective of the Environmental Health Surveillance. Methodology: This study was conducted for three consecutive years in mass event. Risk communication strategies were used for the involvement of stakeholders. In the first experiment, it was measured the level of pollution by particulate matter with aerodynamic size of 2.5 µm and the level of NO2 concentration. In the second experiment, it was carried out the exposure assessment on human health. Results: High levels of pollutants were demonstrated in the first experiment, reaching peaks of up 800 μg/m3 in the circuit of the carnival. Effects of the acute exposure to high concentration of atmospheric pollutants over the ocular surface were demonstrated. The risks communication and management actions contributed to the local regulations. Conclusion: The observed results suggest that the applied tools in risk analysis approach, in its diverse stages, engenders scientific evidences to support the decision-making in local context.

Objectives: To provide a reliable, validated, and culturally adapted instrument that may be used in monitoring dry eye in Brazilian patients and to discuss the strategies for the enhancement of the cross-cultural adaptation and validation process of a self-report measure for dry eye.Methods: The cross-cultural adaptation process (CCAP) of the original Ocular Surface Disease Index (OSDI) into Brazilian Portuguese was conducted using a 9-step guideline. The synthesis of translations was tested twice, for face and content validity, by different subjects (focus groups and cognitive interviews). The expert committee contributed on several steps, and back translations were based on the final rather than the prefinal version. For validation, the adapted version was applied in a prospective longitudinal study to 101 patients from the Dry Eye Clinic at the General Hospital of the University of Sao Paulo, Brazil. Simultaneously to the OSDI, patients answered the short form-36 health survey (SF-36) and the 25-item visual function questionnaire (VFQ-25) and underwent clinical evaluation. Internal consistency, test-retest reliability, and measure validity were assessed.Results: Cronbach's alpha value of the cross-culturally adapted Brazilian Portuguese version of the OSDI was 0.905, and the intraclass correlation coefficient was 0.801. There was a statistically significant difference between OSDI scores in patients with dry eye (41.15 +/- 27.40) and without dry eye (17.88 +/- 17.09). There was a negative association between OSDI and VFQ-25 total score (P < 0.01) and between the OSDI and five SF-36 domains. OSDI scores correlated positively with lissamine green and fluorescein staining scores (P < 0.001) and negatively with Schirmer test I and tear break-up time values (P < 0.001).Conclusion: Although most of the reviewed guidelines on CCAP involve well-defined steps (translation, synthesis/reconciliation, back translation, expert committee review, pretesting), the proposed methodological steps have not been applied in a uniform way. The translation and adaptation process requires skill, knowledge, experience, and a considerable investment of time to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. A well-established guideline resulted in a culturally adapted Brazilian Portuguese version of the OSDI, tested and validated on a sample of Brazilian population, and proved to be a valid and reliable instrument for assessing patients with dry eye syndrome in Brazil. (C) 2015 Elsevier Inc. All rights reserved.

PURPOSE To identify and describe the speech rate and fluency of children with phonological disorder (PD) with and without speech-language therapy. METHODS Thirty children, aged 5-8 years old, both genders, were divided into three groups: experimental group 1 (G1) — 10 children with PD in intervention; experimental group 2 (G2) — 10 children with PD without intervention; and control group (CG) — 10 children with typical development. Speech samples were collected and analyzed according to parameters of specific protocol. RESULTS The children in CG had higher number of words per minute compared to those in G1, which, in turn, performed better in this aspect compared to children in G2. Regarding the number of syllables per minute, the CG showed the best result. In this aspect, the children in G1 showed better results than those in G2. CONCLUSION Comparing children's performance in the assessed groups regarding the tests, those with PD in intervention had higher time of speech sample and adequate speech rate, which may be indicative of greater auditory monitoring of their own speech as a result of the intervention.

Annonaceae is one of the richest families of the Brazilian savanna woody component [1]. Some species have previously showed many biological activities, including insecticidal [2] and cytotoxic [3]. The aim of the present study was to evaluate the main compounds present in Annona coriacea, A. crassiflora, Duguetia furfuracea and Xylopia aromatica and to analyze antioxidant and phytotoxic (lettuce achene germination and seedling growth inhibition) activities. To address this goal, leaves and steams were extracted until exhaustion by ethanol. The extracts were re-suspended in methanol and analyzed by HPLC-DAD. The chromatograms revealed that the extracts showed many phenolic acids and flavonols. The major compounds were rutin, quercetin-3-O-galactoside and kaempferol-3-O-galactoside. The antioxidant activity of the extracts was analyzed by DPPH assay. Almost all extracts had high antioxidant activity, showing EC50 values between 0.02 (X. aromatica leaves) and 0.03 mg/ml (D. furfuracea leaves). A. coriacea leaves had the lowest antioxidant activity (EC50 = 0.06 mg/ml). There was almost no important difference in antioxidant activity between leaves and steams extracts. Although lettuce germination and shoot length were not significantly affected by all the extracts, leaf extract of A. coriacea reduced significantly the development of root lettuce seedlings. These results suggest that the phytotoxic activity may be related to an oxidative stress induced by A. coriacea leaves extract. The high antioxidant activity of the other extracts could have prevented any phytotoxic activity in lettuce roots.

Purpose: To quantify ocular symptoms, goblet cells (GC) and mucin 5AC (MUC5AC) gene expression on the conjunctiva of healthy subjects exposed to ambient levels of traffic-derived air pollution and to estimate its correlation with NO2 and particulate matter smaller than 2.5 mu m (PM2.5) levels.Methods: Twenty-one taxi drivers or traffic controllers were assessed with the Ocular Surface Disease Index (OSDI) questionnaire and conjunctival impression cytology. MUC5AC mRNA levels were determined based on the cytology of the right eye, and GC density was assessed based on the cytology of the left eye. Mean individual levels of 24-h NO2 and PM2.5 exposure were assessed the day before examination. Possible associations between NO2 or PM2.5 levels, OSDI scores, GC densities and MUC5AC mRNA levels were verified.Results: The subjects were exposed to mean PM2.5 levels of 35 +/- 12 mu g/m(3) and mean NO2 levels of 189 +/- 47 mu g/m(3). OSDI scores were low (7.4 +/- 8) and GC densities were 521 +/- 257 and 782 +/- 322 cell/mm(2) on the bulbar and tarsal conjunctivas, respectively. The mean GC-derived MUC5AC mRNA expression was 14 +/- 7 fM/mu g of total RNA. A significant and positive correlation was observed between MUC5AC mRNA levels and tarsal GC density (p=0.018). A trend toward association between PM2.5 levels and tarsal GC cell density (p=0.052) was found.Conclusion: Exposure to ambient levels of air pollution impacts conjunctival GC density. An increase in MUC5AC mRNA levels may be part of an adaptive ocular surface response to long-term exposure to air pollution. (C) 2014 Elsevier Inc. All rights reserved.

Este artigo procura relembrar a trajetória de exclusão provocada pelos tratamentos de dependência química no Brasil e apresenta as formas atuais de tratamentos que objetivam a reinserção social do usuário. Ademais, demonstra que o não cumprimento da política pública sobre o assunto, crenças irreais da população sobre uma forma milagrosa de cura e desconhecimento sobre a legislação e formas alternativas de tratamento, retomam, com novas roupagens, a segregação das pessoas que sofrem com a dependência química, permitindo internações desnecessárias, por ordem judicial e sem o devido processo legal.

Previous studies have revealed that eye contact with either air pollutants or adverse indoor and/or outdoor environmental conditions can affect tear film composition and ocular surface components. These effects are mediated by selective binding of the environmental agents to ocular surface membrane receptors, leading to activation of pro inflammatory signaling pathways. The aim of the current review was to examine the published evidence associated with environmental factors and ocular surface disease and dry eye. Specifically, the reader will appreciate why it is possible to refer to them as mediators of Environmental Dry Eye Disease (EDED), a singular clinical entity inside DED context, directly caused by pollutants and/or adverse climatic conditions. The indicators and clinical findings are described along with EDE differential diagnosis in its acute and the chronic phases. Based on strong existing evidence of clinical reports and epidemiological observations regarding DED and environmental factors we conclude that there is a straight cause-and-effect relationship between ambient stresses and DED. International standards and web-based tools are described for monitoring worldwide environmental conditions referring localities and populations susceptible to EDED. This information is beneficial to health providers to pinpoint the individuals and predisposed groups afflicted with DED. Such insights may not only improve the understanding and treatment of DED but also help to identify the contributing factors and lower the frequency and progression of EDED.

Previous studies have revealed that eye contact with either air pollutants or adverse indoor and/or outdoor environmental conditions can affect tear film composition and ocular surface components. These effects are mediated by selective binding of the environmental agents to ocular surface membrane receptors, leading to activation of pro inflammatory signaling pathways. The aim of the current review was to examine the published evidence associated with environmental factors and ocular surface disease and dry eye. Specifically, the reader will appreciate why it is possible to refer to them as mediators of Environmental Dry Eye Disease (EDED), a singular clinical entity inside DED context, directly caused by pollutants and/ or adverse climatic conditions. The indicators and clinical findings are described along with EDE differential diagnosis in its acute and the chronic phases. Based on strong existing evidence of clinical reports and epidemiological observations regarding DED and environmental factors we conclude that there is a straight cause-and-effect relationship between ambient stresses and DED. International standards and web-based tools are described for monitoring worldwide environmental conditions referring localities and populations susceptible to EDED. This information is beneficial to health providers to pinpoint the individuals and predisposed groups afflicted with DED. Such insights may not only improve the understanding and treatment of DED but also help to identify the contributing factors and lower the frequency and progression of EDED.

PURPOSE. To evaluate the effect of diesel exhaust particles (DEP) on the viability, proliferation, apoptosis, secretion of cytokines (IL-6, IL-8, and TNF-alpha), and mucin gene transcription (MUC1, MUC5AC, and MUC16) in human epithelial cells of the cornea (HCLE) and conjunctiva (IOBA-NHC).METHODS. HCLE and IOBA-NHC cells were incubated with DEP (10-500 mu g/mL) for 24 hours. Cell proliferation was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Apoptotic cells were measured by an annexin V-FITC and propidium iodide kit for flow cytometry. Proinflammatory cytokines were determined by an ELISA kit. Mucin gene transcription was quantified by real-time PCR.RESULTS. DEP significantly decreased the viability, proliferation, and secretion of IL-8, but increased the secretion of IL-6 on both HCLE and IOBA-NHC cell lines in a dose-dependent manner. Neither cornea nor conjunctiva cells incubated with DEP released TNF-alpha. DEP induced a significant increase in the percentage of apoptotic cells in IOBA-NHC, whereas no changes were observed in HCLE. Finally, DEP significantly decreased the transcription levels of MUC1 and MUC16 in HCLE, but increased the transcription levels of MUC1, MUC5AC, and MUC16 in IOBA-NHC.CONCLUSIONS. These findings suggest that human corneal and conjunctival epithelial cells incubated with DEP showed cytotoxicity and an inflammatory response mediated by IL-6, not by TNF-alpha or IL-8. Also, the decrease in mucin expression in the cornea cells might leave exposed areas in the cornea for contact with DEP. Finally, the increase in mucin expression in the conjunctiva cells might be involved at least in the clearance of DEP to protect the ocular epithelium.

Purpose: To evaluate the effect of high levels of environmental air pollution on tear osmolarity and its possible correlation with clinical signs and symptoms.Methods: This was a panel study involving 71 taxi drivers and traffic controllers from Sao Paulo, Brazil. Mean individual levels of 24-hour exposure to nitrogen dioxide (NO2) and particulate matter smaller than 2.5 mu m (PM2.5) were assessed on 4 different occasions. On the first and third visits, subjects were submitted to clinical evaluations including the administration of the Ocular Surface Disease Index questionnaire, slit-lamp examination, estimation of tear breakup time (BUT), the Schirmer test, and vital staining of the cornea and conjunctiva. On the second and fourth visits, tear samples were collected for osmolarity assays. Statistical analysis was performed using generalized estimating equations.Results: Although the taxi drivers and traffic controllers in our sample were exposed to high levels of NO2 and PM2.5, few symptoms were reported on the Ocular Surface Disease Index questionnaire. BUT values were reduced, whereas vital staining and Schirmer test mean results were within normal limits, despite considerable variability. A significant and negative correlation was found between PM2.5 levels and tear film osmolarity levels (P < 0.05). An increase of 10 mu g/m(3) in PM2.5 was associated with a 10.9 mOsm/kg decrease in tear osmolarity. There also was a negative correlation, although not statistically significant, between NO2 and tear osmolarity.Conclusions: Exposure to air pollution reduces tear film stability and influences tear film osmolarity. Combining clinical examination with the assessment of tear osmolarity may help understand ocular surface response to high levels of air pollution.