PURPOSE To report the immediate anatomic and functional alterations in corneal endothelial cells following use of humidified air and dry air during vitreal fluid-air exchange in rabbits. DESIGN Experimental study. METHODS Rabbits undergoing pars plana vitrectomy and lensectomy were perfused with either dry or humidified air during fluid-air exchange for designated durations. Three different experiments were performed. First, control and experimental corneas were examined by scanning electron microscopy (SEM). Second, corneas were stained with Phalloidin-FITC and examined by fluorescein microscopy. Finally, third, transendothelial permeability for carboxyfluorescein was determined using a diffusion chamber. RESULTS While different from the corneal endothelial cells, those cells exposed to humidified air were less stressed than cells exposed to dry air by SEM. Actin cytoskeleton was found highly disorganized with dry air exposure. Humidified air maintained the normal actin cytoskeleton throughout the 20 minutes of fluid-air exchange. Paracellular carboxyfluorescein leakage was significantly higher in dry air insufflated eyes compared with that of the humidified air after 5, 10, and 20 minutes of fluid-air exchange (P =.002, P =.004, and P =.002, respectively). CONCLUSIONS Dry air stress during fluid-air exchange causes significant immediate alterations in monolayer appearance, actin cytoskeleton, and barrier function of corneal endothelium in aphakic rabbit eyes. Use of humidified air largely prevents the alterations in monolayer appearance, actin cytoskeleton, and barrier function of corneal endothelial cells.