Comprehensive Evaluation of Dehydration Impact On Ocular Tissue during Ramadan Fasting

Document Type : Review Article


1 Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Nutrition, School of Medicine, Biochemistry and Nutrition, Endoscopic & Minimally Invasive Surgery, and Cancer Research Centers Mashhad University of Medical Sciences (MUMS Department of Nutrition, School of Medicines, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

4 Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia


The present study aimed to review the effect of dehydration during Ramadan fasting on the health and ocular parameters leading to changes in eye function. Methods: Articles included in the study were taken from Pub Med, Ovid, Web of Science and Google Scholar up to 2014.Related articles were also obtained from scientific journals in fasting and eye. Results: Dehydration and nutrition changes in Ramadan cause an increase in tear osmolarity, ocular aberration, anterior chamber depth, IOL measurement, central corneal thickness, retinal and choroidal thickness. And also a decrease in IOP, tear secretion, and vitreous thickness. Conclusion: Besides many research in relation to effect of dehydration impact on ocular parameters during Ramadan fasting, although the findings reveal it is associated with significant changes on ocular parameters. It seems requisite to have comprehensive study in "fasting and ocular parameters” which will be helpful in making decision and giving plan to the patients.


  1. Shariatpanahi ZV, Shariatpanahi MV, Shahbazi S, Hossaini A, Abadi A. Effect of Ramadan fasting on some indices of insulin resistance and components of the metabolic syndrome in healthy male adults. British Journal of Nutrition. 2008; 100(1):147–151.
  2. Al-Hourani H M, Atoum M F. Body composition, nutrient intake and physical activity patterns in young women during Ramadan. Singapore Med J 2007; 48 (10): 906-909.
  3. Kerimoglu H, Ozturk B, Gunduz K, Bozkurt B, Kamis U and Okka M. Effect of altered eating habits and periods during Ramadan fasting on intraocular pressure, tear secretion ,corneal and anterior Chamber parameters Eye 2010  24, 97–100.
  4. Brucculeri M, Hammel T, Harris A, Malinovsky V, Martin B.Regulation of intraocular pressure after water drinking.J Glaucoma 1999; 8: 111–116.
  5. Kayikcioglu O, Guler C. Religious fasting and intraocular pressure. J Glaucoma2000; 9: 413–414.
  6. Indriss BA, Anas BM, Hicham T. Influence of fasting during Ramadan on intra-ocular pressure.Ann Saudi Med 2008; 28: 61.
  7. Dadeya S, Kamlesh, Shibal F, Khurana C, KhannaA. Effect of religious fasting on intra-ocular pressure.Eye (Lond)2002; 16: 463–465.
  8. Cahill GF Jr. Starvation in man. N Engl J Med 1970; 282:668-75.
  9. Azizi F. Research in Islamic fasting and health. Ann Saudi Med 2002; 22:186-91.
  10. Bayerle-Eder M, Polska E, Kopf A, et al. Free fatty acids exert a greater effect on ocular and skin blood flow than triglycerides in healthy subjects. Eur J Clin Invest 2004; 34:519-26.
  11. Liu JH, Dacus AC. Endogenous hormonal changes and circadian elevation of intraocular pressure. Invest Ophthalmol Vis Sci 1991; 32:496-500.
  12. Bogdan A, Bouchareb B, Touitou Y. Ramadan fasting alters endocrine and neuroendocrine circadian patterns. Meal-time as a synchronizer in humans? Life Sci 2001; 68:1607-15.
  13. al-Hadramy MS, Zawawi TH, Abdelwahab SM. Altered cortisol levels in relation to Ramadan. Eur J ClinNutr 1988; 42:359-62.
  14. Sarraf-Zadegan N, Atashi M, Naderi GA, et al. The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors. Ann Saudi Med 2000; 20:377-81.
  15. Leiper JB, Molla AM, Molla AM. Effects on health of fluid restriction during fasting in Ramadan. Eur J Clin Nutr 2003; 57 suppl 2:S30-8.
  16. Campbell DA, Renner NE, Tonks E. Effect of diamox on plasma bicarbonate and on the electrolyte balance in relation to intra-ocular pressure in man. Br J Ophthalmol 1958; 42:732-8.
  17. Vaajanen A, Luhtala S, Oksala O, Vapaatalo H. Does the renin-angiotensin system also regulate intra-ocular pressure? Ann Med 2008; 40:418-27.
  18. Mustafa KY, Mahmoud NA, Gumaat KA, Gader AMA. The effects of fasting in Ramadan. Br JNutr  1978; 40: 583.
  19. Mena Sadiya,Solafa Ahmed,Hisham Hussain Siddieg, Irish Joy Babas, Martin Carlsson.Effect of Ramadan fasting on metabolic markers,body composition, and dietary intake in Emiratisof Ajman (UAE) with metabolic syndrome .Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy .(2011);4 409–416.
  20. Dilly PN. Structure and function of the tear film. Adv Exp Med Biol 1994;350:239–47.
  21. Fleiszig SM, Mc Namara NA and Evans DJ. The tear film and defense against infection. Adv Exp Med Biol 2002;506:523–30.
  22. Srinivasan S, Nichols K. Collecting tear osmolarity measurements in the diagnosis of dry eye. Expert Rev Ophthalmol 2009;4:451–453.
  23. EkinciKoktekir B, Bozkurt B, Gonul S, Gedik S, Okudan S, Effect of Religious fasting on Tear  Osmolarity and Ocular Surface .Eye & Contact Lens 2014;40: 239–242.
  24. Kayikcioglu O, Erkin EF, Erakgun T. The influence ofreligious fasting on basal tear secretion and tear break up time. Int  Ophthalmol 1999; 22: 67–69.
  25. Sariri R, Varasteh A, Sajedi R.H. Effect of Ramadan fasting on tear Proteins. Acta Medica  2010; 53(3):147–151.
  26. Landsberg LL, Young JB. Fasting, feeding and regulation of the sympathetic nervous system. New Engl J Med 1987; 298:1295–30.
  27. Leiter LA, Grose M, Yale JF, and Marliss EB. Catecholamine responses to hypocaloricdiets and fasting in obese human subjects. Am J Physiol, 1984;247:190–97.
  28. Schaefer S, Wang LF, Vliet A van der, Hristova M, Vulliet PR and Fan SD. Fasting Limits Norepinephrine Release with Myocardial Ischemia and Reperfusion.Cardiovascular Drugs and Therapy. 1999;13:399–405.
  29. Young JB, and Landsberg L. Suppression of sympathetic nervous system during fasting. Am J Physiol 1981; 240:314–19.
  30. Rabbanikhah Z, Javadi M, Karimian F, Rouhani M, Zamani M, Banaee T, et al. Effect of religious fasting on basal tear secretion, tear break up time and intraocular pressure. BINA 2007;12:485-91.
  31. Rabbanikhah Z, Rafati N, Javadi M, Sanago M. Effect of religious fasting on intraocular pressure in healthy individuals. Bina J Ophthalmol 2005; 10:489-92.
  32. Koh S, Tung C, Aquavella J, et al. Simultaneous measurement of tear film dynamics using wavefront sensor and optical coherence tomography. Invest Ophthalmol Vis Sci 2010; 51:3441–3448.
  33. Montés-Micó R. Role of the tear film in the optical quality of the eye.J Cataract Refract Surg 2007; 33:1631–1635.
  34. Dadeya S, Kamlesh, Shibal F, Khurana C, Khanna A. Effect of religious fasting on intra-ocular pressure. Eye (Lond) 2002; 16:4635.
  35. Rohde BH, McLaughlin MA, Chiou LY. Existence and role of endogenous ocular melatonin.J Ocul Pharmacol 1985; 1:235-43.
  36. Buckingham T, Young R. The rise and fall of intra-ocularpressure: the influence of physiological factors. Ophthalmic Physiol Opt 1986; 6: 95–99.
  37. Scott A. Read, Michael J. Collins. Water drinking influences eye length and IOP in young healthy subjects. Experimental Eye Research 91 2010 180-185.
  38. Campbell DA, Renner NE, Tonks E. Effect of diamox on plasma bicarbonate and on the electrolyte balance in relation to intra-ocular pressure in man. Br J Ophthalmol 1958; 42:732-8.
  39. Vaajanen A, Luhtala S, Oksala O, Vapaatalo H. Does the renin-angiotensin system also regulate intra-ocular pressure? Ann Med 2008; 40:418-27.
  40. Nowroozzadeh MH , Mirhosseini AH , Meshkibaf MH , Roshannejad J . Effect of Ramadan fasting in tropical summer months on ocularrefractive and biometric characteristics. Clin Exp Optom 2012; 95: 173–176.
  41. Alameen S.M, Alsiddig A, Albagi. The effect of fasting on intra ocular parameters. Sudanese Journal of Ophthalmology 2014;  6(2):
  42. Hashemi H, Jafarzadehpur E, Ghaderi S, Yekta A.A., Ostadimoghaddam H, Norouzirad R , Khabazkhoob M. Ocular components during the ages of ocular development. Acta Ophthalmologica 2014.
  43. Nema HV, Nema N. Recent Advances in Ophthalmology. 1st ed.New Delhi: Jaypee Highlights Medical Publisher; 2011. p. 172-5.
  44. Assadi M, Akrami A, Beikzadeh F, Seyedabadi M, Nabipour I, Larijani B, et al. Impact of Ramadan fasting on intraocular pressure, visual acuity and refractive errors. Singapore Med J 2011; 52:263-6.
  45. Fong A & Schatz H. Central retinal veinocclusion in young adults. Surv Ophthalmol, 1993; 37: 393–417.
  46. Alghadyan A. Retinal vein occlusion inSaudi Arabia: possible role of dehydration. Ann Ophthalmol 1993, 25: 394–398.
  47. Hoseini-Yazdi shEvaluation of ocular accommodation, convergence and fusional vergence changes during Ramadan. Journal fasting and Health. 2013; 1(1):8-13