title: Ocular surface symptoms in veterans returning from operation Iraqi freedom and operation enduring freedom.
abstract: OBJECTIVE
  To correlate situational exposures and psychiatric disease with self-reported ocular surface symptoms in a younger veteran population involved in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF).
  
  
  METHODS
  Cross-sectional study of all veterans evaluated in the OIF/OEF clinic between December 2012 and April 2013 who completed the dry eye questionnaire and screening evaluations for environmental exposures, posttraumatic stress disorder (PTSD), and depression. The main outcome measures were the influence of environmental exposure and psychiatric disease on ocular surface symptoms.
  
  
  RESULTS
  Of 115 participants, the average age was 33 years. While overseas, exposure to incinerated waste (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.23-5.81, P = 0.02) and PTSD (OR 2.68, 95% CI 1.23-5.85, P = 0.02) were associated with self-reported ocular surface symptoms. On return to the United States, older age (OR per decade 2.66, 95% CI 1.65-4.31, P = 0.04) was associated with persistent symptoms and incinerated waste was associated with resolution of symptoms (OR 0.25, 95% CI 0.07-0.90, P = 0.04). When evaluating symptom severity, 26% of the responders complained of severe ocular surface symptoms, with PTSD (OR 3.10, 95% CI 1.22-7.88, P = 0.02) and depression (OR 4.28, 95% CI 1.71-10.68, P = 0.002) being significant risk factors for their presence.
  
  
  CONCLUSIONS
  PTSD was significantly associated with ocular surface symptoms both abroad and on return to the United States, whereas air pollution in the form of incinerated waste, was correlated with reversible symptoms.
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida.
authors.forename: Yasha S
authors.initials: YS
authors.lastname: Modi
authors.forename: Qirat
authors.initials: Q
authors.lastname: Qurban
authors.forename: Leonid
authors.initials: L
authors.lastname: Zlotcavitch
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Echeverri
authors.forename: William
authors.initials: W
authors.lastname: Feuer
authors.forename: Hermes
authors.initials: H
authors.lastname: Florez
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D015352:Dry Eye Syndromes / Q000453:epidemiology* / Q000209:etiology; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D058014:Veterans Health / Q000706:statistics & numerical data*
chemical_list: D000395:Air Pollutants, Occupational
keywords: PTSD; depression; dry eye symptoms; environmental exposure; posttraumatic stress disorder