TFOS lifestyle: Impact of nutrition on the ocular surface

Maria Markoulli, Jayashree Arcot, Sumayya Ahmad, Reiko Arita, Jose Benitez-Del-Castillo, Barbara Caffery, Laura E Downie, Katie Edwards, Judith Flanagan, Marc Labetoulle, Stuti Misra, Malgorzata Mrugacz, Sumeer Singh, John Sheppard, Jelle Vehof, Piera Versura, Mark D P Willcox, Jillian Ziemanski, James S Wolffsohn

Research output: Contribution to journalArticlepeer-review


Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.

Original languageEnglish
Pages (from-to)226-271
Number of pages46
JournalThe ocular surface
Early online date25 Apr 2023
Publication statusPublished - Jul 2023

Bibliographical note

Copyright © 2023 Published by Elsevier Inc. This accepted manuscript version is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [].


  • Diabetes
  • Diet
  • Dry eye disease
  • Food restriction
  • Gut microbiome
  • Keratitis
  • Lifestyle
  • Mediterranean diet
  • Ocular surface
  • Systematic review


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