The Tear Film and Ocular Surface Society Lifestyle Workshop emphasised the need to identify modifiable risk factors to develop effective prevention strategies for dry eye disease (DED)¹. Among these factors was smoking, including electronic cigarette (e-cigarette) use. While e-cigarettes may often be perceived as a safer alternative to conventional cigarettes, they are frequently linked to adverse health effects. Although there is substantial evidence connecting traditional smoking¹ and smoke exposure² to DED, data on the impact of e-cigarettes and their aerosols on DED are more limited.

In an invited commentary³, OSL team members Drs Michael Wang, Ceecee Britten-Jones (a postdoctoral researcher now based at the University of Melbourne) and Professor Jennifer Craig reviewed a recent study assessing ocular symptoms in adolescents and young adults using e-cigarettes, traditional cigarettes, or both⁴. The study found that dual use was associated with more frequent and severe dry eye symptoms. Despite a lack of detailed information on possible confounding factors and on dosage and frequency of use of the different smoking modes, the study highlights the concerning trend of increasing e-cigarette use among youth and underscores the urgent need for more research on their impact on ocular health.

Future research should ideally explore e-cigarette usage patterns, dosage and their interaction with conventional smoking to fully understand their effects on ocular health. In the meantime, caution continues to be advised as e-cigarette use looks unlikely to mitigate traditional smoking’s recognised side effects on the ocular surface and dry eye.

References

1. Galor A, Britten-Jones AC, Feng Y et al. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf, 2023; 28:262-303.

2. Stapleton F, Alves M, Bunya VY et al. TFOS DEWS II Epidemiology Report. Ocul Surf, 201; 15(3):334-365.

3. Wang MTM, Britten-Jones AC, Craig JP. Electronic Cigarette Smoking and the Eyes. JAMA Ophthalmol. 2023;141(10):946-947.

4. Nguyen AX, Gaiha SM, Chung S et al. Ocular symptoms in adolescents and young adults with electronic cigarette, cigarette, and dual use. JAMA Ophthalmol, 2023; 141(10):937-945.

Dr Kalika Bandamwar is a postdoctoral research fellow in the Ocular Surface Laboratory at the University of Auckland, with a special interest in contact lenses and seeking ways to improve comfortable wear.