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The Tear Function in Electronic Cigarette Smokers

Md Isa, Nur Amalina MOptom, BOptom1*; Koh, Poh Yi BSOptom1; Doraj, Pavithra BSOptom1

doi: 10.1097/OPX.0000000000001422

SIGNIFICANCE Prominent ocular surface dryness and poor tear film quality among electronic cigarette (e-cigarette) smokers (or vapers) indicate potential harm to the eyes from vaping. These findings may serve as precautionary signs for e-cigarette users and exposed bystanders.

PURPOSE Little is known about the effect of e-cigarettes on the eyes except for reported eye irritation among individuals who were exposed to e-cigarette vapors and e-liquids. This study aims to investigate the effect of vaping on ocular surface health of long-term vapers.

METHODS Twenty-one vapers and 21 healthy nonsmokers who are all male underwent measurements of the Ocular Surface Disease Index, noninvasive tear breakup time, fluorescein breakup time, ocular surface staining, tear meniscus height, and the Schirmer test. The effect of voltage used during vaping was also evaluated against the measurements.

RESULTS Vapers experienced moderate-to-severe eye dryness (25.0 [interquartile range, 14.6 to 43.7]) as indicated by the Ocular Surface Disease Index. Significant reductions of noninvasive tear breakup time (3.13 ± 0.97 vs. 6.57 ± 2.31 seconds; P < .0001), fluorescein breakup time (2.68 [interquartile range, 2.33 to 3.18] vs. 4.12 [3.56 to 5.07] seconds; P < .0001), and tear meniscus height (203.0 [193.0 to 225.5] vs. 235.0 [210.0 to 253.50] μm; P = .002) were noted in vapers, but the Schirmer test showed higher results (14.5 [12.0 to 17.0] vs. 8.0 [7.0 to 11.0] mm; P = .001) compared with nonsmokers. Increase in vaping voltage aggravated the dry eye symptoms and tear instability (P < .05). Higher Schirmer test result was also noted as voltage increases.

CONCLUSIONS Vapers showed moderate-to-severe symptomatic dry eye and poorer tear film quality compared with nonsmokers. High vaping voltage may have aggravated the dry eye syndrome because of hazardous by-products from pyrolysis of the e-liquid constituents. Investigation of the ocular surface health at cellular and molecular levels is warranted to gain a deeper understanding on the effect of e-cigarette to the eyes.

1National Institute of Ophthalmic Sciences, Lorong Utara (B), Petaling Jaya, Malaysia


Submitted: February 18, 2019

Accepted: June 12, 2019

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: NAMI, PYK, PD; Data Curation: NAMI, PYK, PD; Formal Analysis: NAMI, PYK, PD; Investigation: NAMI, PYK, PD; Methodology: NAMI; Project Administration: NAMI; Supervision: NAMI; Writing - Original Draft: NAMI; Writing - Review & Editing: PYK, PD.

The authors would like to thank Nurul Fatehah Abdul Aziz for language assistance and Fahim Nazaini as graphic specialist.

© 2019 American Academy of Optometry