Dry eyes in Malaysia: air-con, screens, haze and fasting, and what actually helps

Dry eye is usually a problem of tear quality and blinking, made worse by air-conditioning, long hours on a screen and, for some people, haze and the dehydration of fasting. Lubricating drops, blinking breaks and lid care help most people. Stinging, pain or redness that does not settle needs an eye check, because the cause is often sitting on the eyelid margin, not in the tear bottle.

Why do so many people in Malaysia have dry eyes?

Because the Malaysian day stacks the risks: cold rooms, long screen hours, hot outdoor air and, in some months, haze. Exact national numbers are missing, and the figure most often quoted needs a caveat. It comes from a clinic, not from the street.

That figure is 48.5 per cent. It comes from a 2018 study of dry eye in Kuantan, which reviewed the records of 643 patients at a university eye clinic and found a crude prevalence of 48.5 per cent. The age-adjusted figure was 43 per cent in women under 50 and 68.4 per cent in women aged 50 or over. Because the people studied were already attending an eye clinic, I would not read this as "half of Malaysians have dry eye". It tells you that dry eye is very common among people who walk into an eye clinic, and that women past fifty carry much of it.

Wider data point the same way, with more careful wording. The international TFOS DEWS II epidemiology report found that the prevalence of dry eye ranged from 5 to 50 per cent across studies, rising with age, higher in women, and that Asian ethnicity was a mostly consistent risk factor. A small 2025 study of 110 young adults being assessed for laser eye surgery at Universiti Sains Malaysia found meibomian gland dysfunction in 17.3 per cent and dry eye in 19.1 per cent, and screen exposure of more than four hours a day was strongly associated with both. That is a small group in one hospital, so the odds ratios are wide, but the direction matches everything else.

Does air-conditioning really dry out your eyes?

It can contribute. The NHS and the American Academy of Ophthalmology both name air-conditioning as a cause or trigger of dry eye. No trial has isolated air-conditioning on its own, so I would treat it as a plausible aggravator and not the single cause.

The mechanism is easy to follow. A tear film is a thin layer with an oily top coat that slows evaporation. Dry, moving air strips water from the surface faster. The TFOS Lifestyle review of environmental conditions found that humidity is negatively associated with dry eye, meaning that the lower the humidity, the more dry eye. An air-conditioned office is a low-humidity room by design, and a vent that blows across your desk is moving air on top of that.

The practical points are small ones. Do not sit with a vent pointed at your face. The NHS suggests a humidifier where the air is dry. And be honest about the screen in front of you, because the cold room and the screen usually arrive together.

Do screens cause dry eyes?

Screens do not damage the eye surface by themselves, but they change how you blink, and that is enough to dry it. The American Academy of Ophthalmology gives a normal blink rate of about 15 a minute and about 5 to 7 a minute at a computer. Less blinking means a longer gap between each fresh spread of tears.

Among 795 university students at five Malaysian universities, 89.9 per cent reported symptoms of computer vision syndrome, with headache and eye strain the most bothersome, and symptoms were more frequent in those who used computers for more than two hours a day. Taking breaks to look at distant objects was associated with fewer symptoms, and screen radiation filters were not. The TFOS Lifestyle report on the digital environment adds that the mechanisms behind the surface problems are mainly a lower blink rate and incomplete blinks, together with uncorrected glasses prescriptions, and that blue-light blocking has not been shown to be effective.

Two things follow. First, blinking breaks and a correct prescription are better bets than a filter. Second, not every tired eye at the screen is dry. I cover the glasses, distance and brightness questions in my article on eye strain from screens in adults, and the children's version is in Little Eyes 101's page on dry, gritty eyes in children.

Can haze and pollution make dry eyes worse?

Probably, though the evidence is less clean than the headlines suggest. The TFOS Lifestyle review concluded that pollution is associated with dry eye disease and with conjunctivitis. Its own systematic review found dry eye associated with nitrogen dioxide, but not with carbon monoxide or the coarser particles called PM10.

A 2022 prospective study of 387 people with dry eye across five Chinese provinces found that symptom scores rose with fine particle (PM2.5), ozone and sulphur dioxide exposure, that tear film stability fell with every pollutant measured, and that all the pollutants except sulphur dioxide were associated with worse meibomian gland function. That is a Chinese cohort, not a Malaysian haze season, so I do not want to claim a Malaysian number. What I can say is that an eye that is already marginal has less reserve on a hazy day.

If your eyes are itchy and swollen as well as dry in haze, the cause may be partly allergic, which I explain in the page on haze and your eyelids.

Does fasting during Ramadan dry out the eyes?

The evidence is mixed, so I would not tell anyone they will definitely get dry eyes, or that they definitely will not. A 2015 systematic review of the Ramadan literature concluded that dehydration during fasting is associated with higher tear osmolarity, meaning a saltier tear film, and with lower tear secretion. A 2025 prospective study of 40 people found that prolonged fasting, including no fluid intake, did not lead to significant dryness on symptom scores or on tear measurements, and that the group actually used fewer lubricating drops during the fast.

My reading is that dry eye is not an automatic result of fasting, and that people who already have a fragile tear film, or who spend the day in an air-conditioned office in front of a screen, are the ones who notice it. My own advice, which rests on the dehydration logic and not on a trial, is to drink well between sunset and dawn and to treat the room and the screen first.

Whether eye drops are allowed during the fast is a question for your own religious authority, and I do not answer it here. If you need drops through the day, that is itself a reason to have the eyes examined before the month begins.

Why do the eyelids matter in dry eye?

Because the oil that stops tears evaporating is made in the eyelid. The meibomian glands, a row of oil-producing glands inside each lid, release oil onto the lid margin with every blink. When they block or thin out, the tear film loses its protective top coat and the eye dries even if you make plenty of tears. This is meibomian gland dysfunction, which a 2022 JAMA Ophthalmology review calls a major cause of evaporative dry eye.

It is the part of dry eye that an oculoplastic surgeon spends time on, because the lid margin is the tissue we work on. A lid that sits away from the eye, does not close fully in sleep, or carries crusts and inflamed glands, will keep a dry eye dry however many bottles you buy. I explain how this develops in my article on dry eyes after fifty and the inflamed lid margin in the page on blepharitis.

What actually helps dry eyes, and when should you be seen?

Start with the simple measures: lubricating drops, warm compresses, regular lid cleaning, blinking breaks and a better room. See an eye doctor if the eye is painful, if vision changes, or if you still need drops every day after a few weeks.

The American Academy of Ophthalmology says artificial tears can be used as often as you need, and that preservative-free tears are better if you use them more than six times a day. It also lists warm compresses, which help the oil glands work. The NHS advises cleaning the eyelids every day, taking regular screen breaks, placing the monitor below eye level and considering a humidifier. For which pharmacy drops to avoid, see my guide to pharmacy eye drops for a red eye.

The evidence for the stronger treatments is thinner than the marketing. The TFOS DEWS II management report found that many dry eye treatments lack Level 1 evidence, often because of weak trial design, and recommends a stepped approach matched to severity and to the type of dry eye. That is my reason for starting simple and for examining the lids before anything more elaborate is chosen.

The NHS advises an urgent appointment for a painful red eye or a red eye in a contact lens wearer, and emergency care for sight changes. If you have not had your eyes examined for dryness that has lasted weeks, the eye surface section and my hub article on why eyes look tired are the places to go next. For readers also planning treatments during the fasting month, Retreat Clinic has a page on what changes in aesthetic treatment during Ramadan.