The purpose was to study the effect of long-term exposure to ambient air pollution on the prevalence of dry eye disease (DED) among women. A total of 1356 women, who were recruited in two locations, with different levels of black smoke and sulphur dioxide from the city of Nis were examined to establish the prevalence of DED. A 13-point questionnaire, Tear film break-up time (TBUT), Schirmer's test and Rose Bengal test were used to diagnose dry eye. The univariate and multivariate regression analysis were used to investigate the relationship between long-tem exposure of air pollution and DED adjusted for potential confounding factors (age, passive smoking, keeping of pets, home dampness and use of biomass fuels). Multivariate logistic regression analysis demonstrated significant associations between the presence of DED and exposure to outdoor air pollution (OR = 1.92, 95% CI 1.47-2.52, p<0.001) and passive smoking (OR = 1.13, 95%CI 1.04-1.64, p<0.001). According to our study, exposure to outdoor air pollution of black smoke and sulphur dioxide appear to have a very significant effect on the occurrence of DED at women.