E-cigarette, vaping associated with ocular injury, increased risk for dry eye disease
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Key takeaways:
- E-cigarette users had significant average meibomian gland loss on both lids compared with non-users.
- An increase in e-cigarette voltage was associated with more severe dry eye symptoms.
In addition to accidental ocular injury associated with e-cigarettes, chronic users may experience reduced tear film quality and stability, potentially increasing the risk for dry eye disease, according to a systematic review.
“Electronic cigarette (e-cig) and vaping products have increased in popularity in recent years,” Nilanga Aki Bandara, MS, of the University of British Columbia, and colleagues wrote in the Journal of Clinical Medicine. “Globally, it has been estimated that roughly 68 million people used e-cigs in the year 2020, highlighting the widespread use of these products.”
To examine the effects of e-cig or vaping product use on the ocular surface, Bandara and colleagues conducted a search of Embase, Medicine and Web of Science databases and identified 18 relevant studies. They grouped effects according to non-intended and intended exposures.
According to researchers, non-intended exposures were defined as those caused by the explosions of e-cigs or vaping products, accidental exposure to e-liquid or exposure related to device components breaking. Injuries from e-cig explosions included corneal injuries such as epithelial defects and corneal burn, subconjunctival hemorrhage and black particulate accumulation in the tear film and conjunctiva.
Accidental exposure to e-liquid, which included reports of application when mistaken for eye drops, could result in ocular surface damage ranging from mild eye irritation to chemical injury. Exposures often lead to poison center calls, with one study finding that 87% of calls in the U.S. “had a root exposure that was ocular only.”
Researchers evaluated intended exposures based on potential acute and chronic effects. One study examining acute e-cig exposure found a 1.4 second increase in noninvasive tear breakup time following e-cig use, as well as an increase in mean corneal epithelial thickness in all five zones, although neither met statistical significance.
However, a cross-sectional study found a significant reduction in noninvasive TBUT in chronic e-cig users compared with non-users over 1 year. Researchers also reported that chronic use was linked to disruption of ocular surface components, including tear film quality and stability, which may lead to dry eye and eye irritation. Another cross-sectional study found that TBUT was significantly lower in e-cig users when evaluated using a biomicroscope.
Study findings also showed that e-cig users had significant average meibomian gland loss on both lids compared with controls, as well as irregularly distributed and less hyperreflective meibomian glands. In addition, long-term users of e-cigs had higher Ocular Surface Disease Index scores vs. controls, with increased e-cig voltage associated with more severe dry eye symptoms.
“Given these early findings, efforts should be made to educate e-cig users on the potential effects that vaping can have on their ocular surface, as well as the potential dangers of non-intended exposures,” Bandara and colleagues wrote. “Additionally, policymakers should consider implementing legislation that reduces the potential for ocular harm caused by e-cigs or vaping products, such as restrictions on the containers that e-liquids are available in.”
They added, “Future research should include larger cross-sectional studies and aim at better characterizing the long-term impact that e-cig use has on the ocular surface, especially considering that research on e-cigs and the ocular surface is still emerging.”
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