Eye irritation, for example dry or irritated eyes, is generally among top three reported symptoms in office-like environments, in particular among workplaces with cognitive demanding visual display unit (VDU) work. The symptoms are especially among middle and advanced ages and particularly among women more than men. The symptoms are also among the most commonly reported complaints in the eye clinic. To be in a position to interpret the high prevalence of eye symptoms, a multidisciplinary and integrated approach is necessary that involves the external eye physiology (separate from internal eye effects), eye diseases (evaporative dry eye (DE), aqueous-deficient DE, and gland dysfunctions), and risk factors that aggravate the stability of precorneal tear film (PTF) resulting in hyperosmolarity and initiation of inflammatory reactions. Indoor environmental, occupational and personal risk factors may aggravate the PTF stability; factors such as age, contact lenses, cosmetics, diet, draft, gender, low humidity and high temperature, medication, outdoor and combustion pollutants, and VDU work.Psychological stressors may further influence the reporting behavior of eye symptoms.The impact of the risk factors may occur in a combined and exacerbating manner. The symptoms are also among the most commonly reported complaints in the eye clinic, 8 and dry eye disease (DED) is the most common cause of chronic eye irritation in patients over age of 50. 9,10 These external symptoms, as opposed to internal symptoms such as tired or strained eyes (asthenopia) as already described by Dante in 1304-1307, 11 are categorized as dry eye (DE)-like symptoms.12 The symptoms are especially among middle and advanced ages throughout the world and expected to increase due to visually highly demanding workplaces increase continuously and so does the average age of the workforce.Indoor air pollution and low relative humidity (RH) have been proposed to explain the external DE symptoms; furthermore, a number of occupational and personal risk factors have been suggested to exacerbate the symptom reporting. 13 For instance, high ozone concentrations, especially in aircraft, have been proposed to initiate both gas (homogeneous) and surface (heterogeneous) reactions with reactive substances to produce a complex host of gas-and particle-phase products, for example formaldehyde. 14-16 The key question in search of causality for DE symptoms in office workers is how important indoor air pollution is in comparison with occupational, environmental, and personal risk factors. For instance, reported DE symptoms among young and middle-aged Japanese office workers were significantly higher among those with clinically diagnosed DED (12%) than in those with probable (54%) or undiagnosed DED (34%);