Knowledge-Behavior and Adherence Gap in Protective Eyewear Use Among Outdoor Workers with High Ocular Surface Disease...

Outdoor workers' ocular health in harsh environments is often overlooked, despite their heightened risk of eye disease. This study aimed to examine knowledge of sun-related ocular hazards and adherence to protective eyewear use among outdoor workers in a desert environment, and to contextualize these behaviors against objective ocular surface findings.

A cross-sectional study was conducted among 133 male outdoor workers engaged in cultivation, cleaning, maintenance, and construction at Qassim University, Saudi Arabia, a region characterized by intense solar ultraviolet radiation, high ambient temperatures, low relative humidity, and frequent dust storms. Participants underwent comprehensive ocular surface evaluation, including slit-lamp biomicroscopy and objective tear film assessment using the Keratograph 5M. Knowledge of UV-related ocular hazards was assessed using items adapted from a validated UV knowledge instrument, and self-reported protective eyewear adherence during outdoor work was recorded.

Protective eyewear adherence was low: 59.4% of workers reported never using eye protection during outdoor work, while only 8.3% reported consistent use. Lower knowledge of sun-related ocular health risks was observed in 63.2% of participants. Objective clinical signs consistent with dry eye disease were observed in 54.1%, and pinguecula was observed in 45.9%. Knowledge level and protective eyewear use were not significantly associated with DED or pinguecula.

These findings show a clear gap between what workers know about eye protection and how often they actually use it. The combination of low protective eyewear use and a high observed burden of ocular surface disease suggests that education alone may not be enough. Although workplace factors were not directly measured, workplace-level support, easier access to suitable protective eyewear, and practical eye-health education tailored to workers' needs represent plausible, testable directions for improving protection in desert outdoor work settings.