Effects of chronic smoking on central corneal thickness, endothelial cell, and dry eye parameters

Demographic and lifestyle factors associated with dry eye disease in China: A cross-sectional multi-center study

PURPOSE

Associations were assessed between demographic/lifestyle factors and tear film breakup time (TBUT) defined dry eye disease (DED) in China.

METHODS

The cross-sectional study involved 50,280 subjects (54 ± 17 y) in 217 clinics (25 provinces). Data included sleep disorders; digital screen exposure; and use of cosmetics, contact lenses, and eye drops (for asthenopia). Clinical examinations included TBUT; Schirmer I test; meibomian gland plug status. TBUT-defined DED was TBUT <10 s, with TBUT ≤5 s also considered (i.e., short TBUT-type DED), either unilateral or bilateral.

RESULTS

TBUT-defined DED was present in 81.6 % overall. The highest rates were in those 71 years or older, living in the north, with chronic daily sleep disorder, or daily cosmetic application; or daily digital screen exposure for 5 years, contact lenses 4 h, or 3 months eye drops. Compared with those without TBUT-defined DED, those with TBUT-defined DED showed lower Schirmer I results and more severe meibomian gland plug status (each, P < 0.001). Independent risk factors of DED were: aging; living in the southwest; daily digital screen exposure ≥3 h; and occasional cosmetic use. Risk factors of DED TBUT ≤5 s were: living in the southwest; wearing contact lenses (>3 y); and using eye drops. Rates of unilateral and bilateral DED were comparable.

CONCLUSIONS

DED in China is more likely in the aged and those in the north/southwest. DED rates increase with digital screen exposure, and use of cosmetics, contact lenses, or eye drops for asthenopia. Unilateral DED should be treated as promptly as bilateral.

Analysis of cardiovascular risk factors for the viability of cornea donors: a case-control study

OBJECTIVE

The main objective of the study was to evaluate the influence of arterial hypertension, diabetes, dyslipidaemia, smoking, alcoholism and COPD (chronic obstructive pulmonary disease) on the viability of the extracted tissue as well as the donor.

DESIGN

Observational case-control study.

SETTING

Regional hospital in Northern Spain.

PARTICIPANTS

1517 corneas were registered.

INTERVENTIONS

Patients' medical history was reviewed after corneal donation and evaluation. Previous medical information (age, sex and cardiovascular risk factors (CVRFs)) and data related to the donor (type of donor), the corneal tissue and its evaluation, and the viability of the implant were collected.

RESULTS

A total of 1517 corneas were registered and 81.5% of the donors presented at least one CVRF. In relation to the viability of the donor, it was observed that having suffered from COPD reduced the viability of the donor (no COPD: 93.8% vs COPD: 88%; OR=0.49; 95% CI: 0.28 to 0.84) while alcohol consumption increased it (drinker or ex-drinker: 95.8% vs non-drinker: 92.5%; OR=1.84; 95% CI: 1.01 to 3.33). Regarding tissue viability, decreased viability was observed in the presence of COPD (no COPD: 72.5% vs COPD: 64; OR=0.67; 95% CI: 0.47 to 0.96) and diabetes mellitus (no diabetes: 72.9% vs diabetes: 67.2%; OR=0.76; 95% CI: 0.58 to 0.99). As regards the viability of the implant, a total of 1039 corneas (68.9%) were suitable, observing decreased viability when suffering from COPD (no COPD: 69.8% vs COPD: 60.7%; OR=0.67; 95% CI: 0.47 to 0.94) and increased when having an active smoking habit (no habit: 65.3% vs habit: 74.1%; OR=1.52; 95% CI: 1.21 to 1.91).

CONCLUSIONS

Through this study, it can be concluded that in the absence of absolute exclusion criteria for donors, the assessment of how CVRF, alcoholism and COPD may affect the donor provides details about the quality of the tissue to be obtained.

Effects of chewing tobacco on corneal endothelium in patients with diabetes mellitus

OBJECTIVE

To determine the impact of tobacco chewing on corneal endothelial structure in patients with diabetes mellitus (DM).

METHODS

Corneal endothelial parameters (endothelial cell count, ECD; coefficient of variation, CV; hexagonality, Hex, and central corneal thickness, CCT) were analysed in 1234 eyes of 1234 patients using non-contact specular microscopy (EM 4000 Tomey Nishi-Ku, Nagoya, Aichi, Japan). The study group (with a present history of tobacco chewing) comprising of 948 subjects, with 473 having DM was compared with age and gender-matched control group comprising of 286 subjects (139 having DM) with no history of tobacco use in any form.

RESULTS

Tobacco chewers had a significantly reduced ECD (P = 0.024) and Hex (P = 0.009) as compared with non-chewers. Similar results were noted in ECD (P = 0.004) and Hex (P = 0.005) in patients with DM. Tobacco chewers had a significantly decreased ECD values among males, HbA1C ≤ 7.5% and duration of DM ≤ 20 years, and significantly decreased Hex among those with >50 years of age, females, and duration of DM > 20 years. The CV and CCT values were comparable between the study and the control groups. Tobacco chewers showed a significant association of ECD with age, HbA1C, and duration of DM; CV with HbA1C; Hex with age and duration of DM; and CCT with gender, age, HbA1C and duration of DM.

CONCLUSIONS

Tobacco chewing may negatively impact corneal health, especially confounded by additional factors like age and DM. These factors must be accounted for in the pre-operative evaluation of such patients prior to any intra-ocular surgery.

The environment and dry eye-manifestations, mechanisms, and more

Dry eye disease (DED) is a multifactorial condition that often presents with chronic symptoms of pain (that can be characterized as "dryness," "burning," and "irritation," to name a few) and/or fluctuating or poor-quality vision. Given its multifactorial nature, several pathophysiologic mechanisms have been identified that can underlie symptoms, including tear film, ocular surface, and/or corneal somatosensory nerve abnormalities. Research has focused on understanding how environmental exposures can increase the risk for DED flares and negatively impact the tear film, the ocular surface, and/or nerve health. Given that DED is a common condition that negatively impacts physical and mental functioning, managing DED requires multiple strategies. These can include both medical approaches and modulating adverse environmental conditions, the latter of which may be a cost-effective way to avoid DED flares. Thus, an understanding of how environmental exposures relate to disease is important. This Review summarizes research on the relationships between environmental exposures and DED, in the hope that this information will engage healthcare professionals and patients to consider environmental manipulations in their management of DED.

TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface

Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.

Smoking and environmental tobacco smoke exposure: implications in ocular disorders

PURPOSE

This article aims to gather and review the available knowledge on several implications of smoking and environmental tobacco smoke (ETS) exposure in ocular disorders and provides pathomechanistic insights where applicable.

MATERIALS AND METHODS

PubMed and Scopus databases were searched for relevant studies on the association of smoking and ETS exposure with various ocular disorders. Studies with different evidence levels, e.g., in-vivo, case-control, cohort, and meta-analysis, were included.

RESULTS

Smoking is an established, modifiable risk factor in several ocular diseases, including cataract, age-related macular degeneration, and Graves' ophthalmopathy; smokers are subject to more severe disease courses and less favorable treatment outcomes. Uveitis is twice as likely in smokers; smoking may also delay its resolution. Smoking and ETS exposure are major risk factors for diseases of other organs, with associated ocular complications as well, such as diabetes mellitus. ETS exposure is also associated with ocular surface pathologies, including dry eye syndrome. In children, early-life ETS exposure and maternal smoking during pregnancy are strongly associated with refractive errors and strabismus. Currently, available data on potential risks attributable to ETS exposure regarding ocular diseases are scarce and, in some instances, controversial.

CONCLUSION

In addition to smoking, ETS exposure is also a significant public health concern with possible links to several ocular diseases. However, the level of education of at-risk populations in this regard does not match the strength of the evidence.

Prevalence of pesticide related occupational diseases among Indonesian vegetable farmers - A collaborative work

Objective

This study was done to understand the prevalence of various occupational diseases including dry eyes, nail dystrophy, and neuropathy related to pesticide exposure in Indonesian local vegetable farmers.

Methods

The data were collected through questionnaires and physical examination involving dermatology, neurology, and ophthalmology domains at Ngablak District, Magelang, Central Java directed to local vegetable farmers. Ocular Surface Disease Index (OSDI) questionnaire and the Schirmer test were used. Analysis was done using descriptive statistics using the Statistical Package for the Social Sciences (SPSS 21.0) and presented in tables.

Results

Inadequate spraying equipment and improper storage of pesticides were found. Out of 105 farmers, 41.9 % experienced occupational skin diseases (OSD). Definite cognitive impairments were found in 3.4 % of subjects but probable in 28.3 % of subjects. Neuropathies were found in 61.7 % of subjects, and dry-eyes syndrome were found in 28.78 % of subjects.

Conclusion

There was a high prevalence of peripheral neuropathy and tremor, dry eyes syndrome in one-third of the population, and the most common skin problem was nail discoloration, with a low incidence of contact dermatitis.

Assessment of Tear Osmolarity in Smokers Using TearLab and I-Pen Systems

Purpose. Smoking has a negative effect on health and ocular tear film. The purpose of the current study is to investigate the correlation between the TearLab and I-Pen osmolarity scores in smokers and compare them with those of non-smoking healthy males. Methods. Thirty male smokers (25.3 ± 2.2 years) participated in the study. An age-matched (22.9 ± 2.0 years) control group of non-smoking healthy males (N = 30) was also recruited for comparison purposes. The ocular surface disease index (OSDI) was completed first, followed by the TearLab and I-Pen osmolarity measurements. Results. The median TearLab osmolarity score was lower (P < 0.001) than that obtained using the I-Pen in both the study and the control groups. The OSDI scores and osmolality measurements were higher (P < 0.001) in smokers than in the control subjects. In the smoker group, there were moderate correlations between the OSDI scores and the measurements obtained using the TearLab (Spearman’s correlation coefficient, r = 0.463; P = 0.010) and I-Pen (r = 0.449; P = 0.013) systems. In addition, there was a strong correlation between the osmolarity scores obtained from the TearLab and I-Pen systems in smokers (r = 0.911; P < 0.001). Conclusion. The I-Pen scores in smokers were significantly higher than those obtained using TearLab. The TearLab scores showed small variations compared with those obtained using I-Pen. A strong correlation was found between the TearLab and I-Pen scores in smokers. The osmolarity TearLab and I-Pen scores were significantly higher in smokers compared with normal eye subjects.

Effects of Type 2 Diabetes Mellitus and Smoking on Changes in Corneal Endothelial Morphology and Cell Density

PURPOSE

The purpose of this study was to compare the corneal endothelial morphology and cell density of diabetic smokers and nonsmokers with 50 to 70 age-matched healthy subjects and to determine whether smoking increases the effects of type 2 diabetes mellitus (DM) on these corneal parameters.

METHODS

This prospective cohort study included 200 patients who were assigned to 4 groups, including smokers with type 2 DM (group 1), nonsmokers with type 2 DM (group 2), healthy smokers (group 3), and healthy nonsmokers (control group, group 4). Noncontact specular microscopy was used to measure central endothelial cell density (ECD), coefficient of variation of cell area, percentage of hexagonal cells, and central corneal pachymetry (CCT).

RESULTS

According to the ECD and CCT values ( P < 0.001 and P = 0.013, respectively), a significant difference was observed between the groups. The mean ECD was lowest in diabetic smokers (1917 ± 399 cells/mm 2 ). Healthy smokers and diabetic smokers had significantly lower ECD compared with the control group ( P = 0.03 and P < 0.001, respectively). Healthy smokers and diabetic smokers had significantly lower ECD compared with diabetic nonsmokers ( P = 0.012 and P < 0.001, respectively). The cornea was significantly thicker in the diabetic smokers than in the control group ( P = 0.013).

CONCLUSIONS

The coexistence of DM and smoking causes a significant decrease in ECD and an increase in CCT. Cigarette smoking is more harmful to corneal endothelial cells than DM alone.

Corneal endothelial cell density and its correlation with birth weight, anthropometric parameters, and ocular biometric parameters in Chinese school children

Background

To describe the distribution of corneal endothelial cell density (ECD), and to explore its correlation with birth weight (BW), anthropometric parameters, and ocular biometric parameters in Chinese school children.

Methods

In the population-based cross-sectional Nanjing Eye Study, children were measured for anthropometric information, for ECD by the noncontact specular microscope and for ocular biometric parameters by the optic low-coherent reflectometer. Data from right eyes were analyzed to illustrate the distribution of ECD and for determining correlated factors with ECD using univariate and multiple linear regression analysis. Comparisons among three different BW groups were performed using a one-way ANOVA analysis followed by the Bonferroni correction for pairwise comparisons.

Results

Of 1171 children, the mean (± standard deviation) ECD was 2875.34 ± 195.00 cells/mm². In the Multiple Linear Regression analysis, BW, gender and central corneal thickness were significantly associated with ECD. The ECD increased by 36.16 cells/mm² with BW increasing by 1 kg (P = 0.001) and increased by 0.44 cells/mm² for every additional 1 mm in central corneal thickness (P = 0.01). The ECD of girls was 54.41 cells/mm² higher than boys (P < 0.001). Children born with low BW presented significantly lower ECD than those born with normal BW (P < 0.05) and high BW (P < 0.05). Age and axial length were not significantly associated with ECD (P = 0.06 and P = 0.21, respectively).

Conclusions

In Chinese school children aged 82 to 94 months, the ECD is positively correlated with BW and central corneal thickness, in which BW is a newly identified associated factor. It is like that gender plays an important role in ECD distribution while girls have relatively greater ECD than boys.

The effects of tobacco waterpipe smoking on the ocular surface

CLINICAL RELEVANCE

This study was conducted to determine the effect of tobacco waterpipe smoking on the ocular surface. The findings could be useful in understanding ocular surface changes and associated symptoms in waterpipe smokers.

BACKGROUND

Tobacco smoking has been reported to have many systemic and ocular adverse effects. However, the effect of specific delivery methods of tobacco using a waterpipe on the eye has not been commonly studied.

METHODS

This study enrolled 33 waterpipe smokers (with no history of cigarette smoking) and 31 non-smokers of age-matched control group. Participants were tested in the following sequence: the presence of ocular symptoms using Ocular Surface Disease Index questionnaire, tear osmolarity, tear film break-up time and corneal staining. Statistical analysis using unpaired sample t-tests was performed to study the difference in ocular surface parameters obtained for each group. The prevalence of dry eye disease was also measured in each group.

RESULTS

The mean tear osmolarity values and corneal staining were significantly higher (P < 0.05) in the waterpipe smoking group (314.64 ± 15.24 mOsm/L and 0.73 ± 0.94, respectively) compared to non-smokers (306.42 ± 13.48 mOsm/L and 0.10 ± 0.30, respectively). The mean values obtained from tear film break-up time test were significantly lower (P < 0.05) in the waterpipe smoking group (5.82 ± 3.77 s) compared to non-smokers (8.32 ± 3.46 s). The difference in the average Ocular Surface Disease Index scores in the study groups was not statistically significant (P > 0.05). The prevalence of dry eye disease was significantly higher (p < 0.05) in the waterpipe smoking group (57.6%), compared to the control group (35.5%).

CONCLUSION

Waterpipe smoking could have a significant effect on tear film parameters and be associated with dry eye disease. Dryness also seems to be more prevalent among waterpipe smokers.

Chromatic Contrast Sensitivity Functions and Colour Discrimination in Smoker Patients

In this study, effects of smoking on colour vision with the Farnsworth−Munsell 100 Hue test (FM100h) and achromatic (A), red-green (RG), and blue-yellow (BY) contrast sensitivity functions were evaluated. In total, 50 non-smoker controls and 25 smokers, divided into two groups (group 1, less than 10 cigarettes per day, with 15 patients, and group 2, >10 cigarettes per day, with 10 patients) took part in the experiments. Best-corrected visual acuity (BCVA), FM100h, and A, RG, and BY contrast sensitivity functions were measured. Total and partial RG and BY error scores (TES and PTES) and colour axis index (CA) were used in the analysis. No differences between smoker and non-smoker groups were found in BCVA, CA and A and BY contrast sensitivity, but TES and PTES values and RG contrast sensitivity at 1 cpd were statistically different. Differences between smoker groups were not significant. Error scores in smokers were positively correlated with the number of cigarettes smoked per day, and in BY also with age. Tobacco caused discrimination losses in both chromatic mechanisms but affected the red-green pathway more than the blue-yellow, and therefore, a partial RG score of FM100h test seems to be a good predictor of smoker colour deficiencies.

Analysis of risk factors of rapid attenuation of graft endothelium in the early stage after penetrating keratoplasty

This study aimed to analyze the factors of rapid attenuation of graft endothelium in the early stage after penetrating keratoplasty (PKP), with a view to guiding patients with PKP to better long-term outcomes. This study included 226 patients who underwent PKP with follow-up time >1 year at the Qingdao Eye Hospital of Shandong First Medical University from January 2018 to June 2020. Medical records were retrospectively studied, and donor factors, patient factors, and surgical factors were comparatively analyzed to clarify those affecting the rapid decay of graft endothelium after PKP. The median time between excision and death >60 min and patient age >60 years were risk factors for endothelial cell loss (ECL) rate >30% at 1 month postoperatively. However, a higher percentage of patients with donor age ≤60 years and Optisol preservation solution had endothelial cell density (ECD) >2000 cells/mm² in the graft at postoperative 1 year. A year after the surgery, patients with corneal endothelial decompensation and immune rejection were at risk for ECD < 1000 cells/mm². The combined operations had a significant effect on the ECL in the early postoperative period. Patients who underwent combined extracapsular cataract extraction or intraocular lens implantation had a significantly higher rate of ECL at postoperative 1 month than other patients, and no significant effect at postoperative 1 year. However, patients without combined operations have a higher probability of maintaining a high level of graft ECD. The graft diameter also affected postoperative ECL. In patients with a larger graft diameter, attenuation of ECD was slower. The ultimate goal of PKP is to maintain graft transparency for extended periods. The use of younger donors, minimizing unnecessary operation in the anterior chamber, and minimizing immune rejection may maintain a greater donor corneal endothelium in the long term.

Impact of tobacco use on corneal thickness and endothelial health: a systematic review with meta-analyses

PURPOSE

To investigate the impact of tobacco use on corneal thickness and corneal endothelial health.

METHODS

We searched the PubMed/MEDLINE, EMBASE, the Cochrane Central and all affiliated databases of the Web of Science on 20 July 2020. Two authors reviewed the studies and extracted the data in an independent fashion. Studies were reviewed qualitatively in the text, and central corneal thickness (CCT) and corneal endothelial characteristics (endothelial cell density, endothelial cell variability, average of endothelial cell size and endothelial cell hexagonality) were introduced for quantitative analyses.

RESULTS

Eighteen studies (2077 were smokers and 6429 non-smokers) were identified, of which 17 studies provided data eligible for one or more of the quantitative analyses. When compared to non-smokers, smokers had a higher CCT (+3.3 μm, 95% CI: +0.9 to +5.7 μm, p = 0.007) and a lower endothelial cell density (-140 cells/mm² , 95% CI: -30 to -250 cells/mm² , p = 0.01). Other corneal endothelial measures did not differ significantly.

CONCLUSION

Tobacco use is associated with a higher CCT and lower corneal endothelium cell density, but the clinical impact of these findings is small. Further studies are warranted on patients with a priori poor corneal health, where smoking may constitute an important risk of further progression, for example upon anterior segment surgery.

Estimated Annual Economic Burden of Dry Eye Disease Based on a Multi-Center Analysis in China: A Retrospective Study

Purpose: To conduct a multi-center analysis and assess the economic burden due to dry eye disease (DED) in China. Design: A retrospective and cross-sectional study. Methods: Patients (n = 598) with diagnosed DED were recruited from 3 eye centers (in central, southeast, and northeast China) from 1 January 2018 to 31 December 2018. Data were collected regarding the examination, pharmacological therapy, and non-pharmacological therapy fees. Sub-group analyses were stratified by eye center, DED severity, types of DED, number of visits to physicians, and residential area. A logistic regression analysis was conducted to investigate the variables influencing total costs. Results: The per capita costs devoted to DED at the 3 centers were 422.6, 391.3, and 265.4 USD, respectively. The costs of non-pharmacological therapy accounted the largest part in three centers (75.6, 76.4, 76.5%, respectively). Patients with severe DED sustained the largest economic burden. Patients with mixed type of DED spent the most comparing to patients with either evaporative or aqueous-deficient types of DED. Patients spent more during the first visit compared with subsequent visits. Patients living in urban areas spent significantly more than did those living in rural areas (P = 0.001). The logistics regression analysis showed that total costs were significantly influenced by DED severity, number of visits to physicians, and area of residence (beta = 2.83, 0.83, 1.48; P < 0.0001). Conclusions: DED is a chronic ocular disease that timely non-cost counseling, early diagnosis, and efficacious treatment can reduce its economic burden on patients and the society.

Association Between Tobacco Consumption and Self-Reported Visual Impairment in Adults of High-Altitude Andean Communities of Peru

To determine the association between tobacco consumption and self-reported visual impairment. We performed a cross-sectional study based on an original cohort study. A non-probabilistic sampling was performed to invite 413 patients of 60 years or more from 11 high-altitude Andean communities (altitude higher than 1500 m above sea level) of Peru between 2013 and 2017. Demographic data and information on tobacco consumption were collected. Associations were determined using a Poisson regression model with 95% confidence intervals (CI). Of the 413 participants, 141 (34.14%) were men and 49 (11.86%) were tobacco users. In the adjusted model, tobacco users presented a high probability of visual impairment with a prevalence ratio of 1.32 (95% CI: 1.18–1.97). We also found that having two or more comorbidities 2.19 (95% CI: 1.53–3.15), receiving health assistance in a pharmacy 3.75 (95% CI: 1.97–7.16), and coffee consumption 1.67 (95% CI: 1.26–2.21) were factors significantly associated with self-reported visual impairment. We determined that in Peruvian high-altitude Andean communities, visual impairment was more frequent in individuals reporting tobacco consumption, taking alternative medicine, going directly to a drug store without primary care physician consultation, having more than one comorbidity, and coffee consumption.

The effect of active smoking, passive smoking, and e-cigarettes on the tear film: An updated comprehensive review

Active tobacco smoking, passive smoking, and e-cigarette smoking have been associated with different systemic and ocular diseases. The precorneal tear film plays an important role in eye health and its analysis can provide useful information on ocular status. This review investigates the effects of different types of smoking on the precorneal tear film, by analyzing the peer-reviewed literature on this topic. Specifically, tear evaporation rate, stability, volume, ferning, osmolarity, and physical composition (lipids and proteins) of tear film are detailed. Most of the reported works show that cigarette smoking reduces tear film stability and quality by affecting its components. This review highlights that smoking severely affects the tear film, but a single test is not sufficient to determine these effects because smoking can impact different parts of the eye.

The effect of smoking on ocular surface and tear film based on clinical examination and optical coherence tomography

Purpose:

Smoking is a global health problem with a high burden of smokers in India and the world as well. Smoking is a known eye irritant that may have a significant effect on the anterior ocular surface. Hence, the present study was aimed to investigate the effect of smoking on dry eye parameters, ocular surface, and central corneal thickness (CCT) and to compare the results with nonsmokers.

Methods:

In this cross-sectional study, 40 (80 eyes) smokers and 40 (80 eyes) age-matched nonsmokers were included. The severity of ocular surface disease symptoms was assessed by the Ocular Surface Disease Index (OSDI) tool. All participants underwent a series of measurements, that is, the Schirmer’s II test score and tear breakup time (TBUT). Tear meniscus height (TMH) and CCT were measured using anterior segment optical coherence tomography (OCT).

Results:

The mean value of all dry eye parameters was statistically different among the group of smokers and nonsmokers. The mean score of symptomatic assessment (OSDI) was observed to be significantly higher in smokers than in nonsmokers (P < 0.0001), and dry eye parameters, that is, Schirmer’s score (P = 0.0127), TMH (P < 0.0001), and TBUT (P < 0.0001) were significantly lower among smokers than nonsmokers. There was no significant difference in CCT between smokers and nonsmokers (P = 0.06).

Conclusion:

Cigarette smoking has deteriorating effects on the ocular surface. Exposure to smoking was found to be associated with dryness of the eye. Further studies are needed on a molecular basis.

The effect of smoking on corneal densitometry and endothelial cell morphology

PURPOSE

We investigated corneal endothelial morphology and corneal densitometry in smokers and compared our results with findings observed in non-smokers.

MATERIALS AND METHODS

This cross-sectional observational study included 100 participants (50 smokers, 50 non-smokers) aged 18-80 years in whom corneal endothelial morphology was analysed using a non-contact Tomey EM-4000 specular microscope (Tomey Corporation, Japan). The Pentacam HR system was used to measure corneal densitometry spatially in three concentric zones (from the centre to the periphery) and at three different corneal depths (from the anterior to the posterior aspects). Endothelial morphology findings and corneal densitometry values were recorded in all participants, and these results were compared between smokers and non-smokers.

RESULTS

Endothelial morphology and corneal densitometry analysis showed significantly lower endothelial cell counts (Num) in smokers (228 cells/mm² vs. 246 cells/mm², p = 0.02) in addition to increased maximum cell area (Max) values (986.5 µm² vs. 935 µm², p = 0.04). We observed no statistically significant intergroup difference in corneal densitometry values (p > 0.05 for each zone); however, we observed a moderately positive correlation between densitometry values in the 6-10 mm concentric zone and between the all total corneal zones and number of pack-years in smokers.

CONCLUSIONS

Our study highlights that among the morphometric corneal endothelial variables analysed in this study, only the Num value was significantly correlated with smoking. We observed no statistically significant intergroup difference in corneal densitometry values in this study; however, a positive correlation was observed between the number of pack-years and corneal densitometry findings. Therefore, as the pack-years increase, the increase in corneal densitometry values may indicate a decrease in corneal clarity, considering the possible contribution of secondary factors such as age.

Evaluation of the corneal endothelium by specular microscopy in patients with chronic obstructive pulmonary disease

OBJECTIVE

The objective of this study is to evaluate the corneal endothelium in patients with chronic obstructive pulmonary disease (COPD) using a specular microscope.

METHODS

The right eyes of 64 patients with a COPD diagnosis and 65 healthy individuals were evaluated. Cell density (CD) (cell/mm² ), corneal thickness (CT) (μ), hexagonal cell ratio (%), and coefficient of variation (cell area standard deviation/mean cell area, μm² ) were analyzed by specular microscopy (SM).

RESULTS

The CT was significantly reduced in the COPD group compared with the control group (P = 0.021). Moreover, a significant difference was found between the COPD group and the control group in terms of corneal endothelial CD (P = 0.011), hexagonal cell ratio (P = 0.008), and coefficient of variation (P = 0.012).

CONCLUSION

The corneal endothelial structure was significantly deteriorated in patients with COPD compared with the control group. SM is a valuable method that could be used in treatment and follow-up of corneal endothelium in patients with COPD.

Dry Those Crying Eyes: The Role of Depression and Antidepressants in Dry Eye Disease

PURPOSE/BACKGROUND

Several clinic-based and large population studies have associated a depression diagnosis or depression severity with dry eye disease (DED) or symptoms. On the other hand, several other large population studies have found that antidepressant use was also associated with DED. Unfortunately, many of the studies finding associations between depression and DED did not control for concomitant antidepressant use, whereas the ones that found associations between antidepressant use and DED did not control for severity of depression or other psychiatric indications for selective serotonin inhibitor use. The purpose of this review was to identify whether depression and antidepressants play an independent role from one another in the onset of DED.

METHODS/PROCEDURES

A systematic literature review was conducted searching for DED studies that adjusted for concomitant antidepressant use in depressed patients, that adjusted for depressive symptoms in patients taking antidepressants, and that enrolled depressed patients who were not taking psychiatric medications at the time of the study. Additionally, the prescribing information of marketed antidepressants was reviewed to determine rates of dry eyes reported during clinical trials.

FINDINGS/RESULTS

The literature review initially identified 43 studies with 13 fitting the inclusion criteria. Although these studies varied in their quality, 7 revealed statistically significant associations between depression and DED, whereas 7, including 1 randomized trial, revealed significant associations between antidepressants and DED. Sixteen percent of the antidepressant package inserts inspected reported DED symptoms as an infrequent risk.

IMPLICATIONS/CONCLUSIONS

This review suggests that independent of one another, both depression and antidepressant use are associated with DED.

Clinical and laboratory features of patients with focal lymphocytic sialadenitis on minor salivary gland biopsy for sicca symptoms: A single-center experience

Minor salivary gland biopsy (MSGB) is often used in patients lacking specific autoantibodies (seronegative patients) to confirm the presence of focal lymphocytic sialadenitis (FLS), which would suggest a diagnosis of Sjogren syndrome. There are no current guidelines indicating when to refer patients for MSGB. The objective of our study was to ascertain distinguishing clinical and laboratory features among individuals with sicca symptoms based on their serologic and histopathologic status, and to identify factors associated with FLS.Using a cross-sectional study design, patients ages 18 years or older with sicca symptoms who had MSGB performed at the University of Iowa from January 2000 to December 2016 were selected for chart reviews. The clinical and laboratory features of patients with and without FLS were analyzed using exact univariate and multivariable logistic regression, with Bonferroni correction for multiple comparisons.We identified 177 patients who had MSGB performed and available clinical data. A total of 133 patients had FLS, 37 (27.8%) were seropositive (positive-anti-Sjogren syndrome type A [SSA] and/or anti-Sjogren syndrome type B) and 96 (72.2%) were seronegative. Dry eyes (unadjusted odds ratio [OR]: 5.17, 95% confidence interval [CI]: 1.16-26.30; adjusted odds ratio [aOR]: 12.58, 95% CI: 1.70-167.77) and the presence of anti-SSA (OR: 7.16, 95% CI: 1.70-64.24; aOR: 8.82, 95% CI: 1.73-93.93) were associated with FLS. Smoking (aOR 0.27, 95% CI: 0.11-0.63) and antihistamine use (aOR 0.23, 95% CI: 0.08-0.63) were associated with lower odds of FLS.Our study suggests that dry eyes and anti-SSA positivity are associated with FLS. Smoking and antihistamine use were associated with lower odds of FLS. In the appropriate clinical context, seronegative patients with sicca symptoms and no smoking history could be considered for MSGB. A thorough medication and smoking history should be performed in all patients before referral for MSGB.

Systemic Conditions Associated with Severity of Dry Eye Signs and Symptoms in the Dry Eye Assessment and Management Study

PURPOSE

Certain systemic conditions are reported to be risk factors for dry eye disease (DED), but their associations with DED severity are not well studied. We evaluated whether systemic conditions reported to be DED risk factors are associated with severity of DED signs and symptoms.

DESIGN

Secondary analysis of data from the Dry Eye Assessment and Management Study, a large-scale multicenter randomized clinical trial of patients with moderate to severe DED.

PARTICIPANTS

Five hundred thirty-five adult patients with moderate to severe DED from 27 United States centers.

METHODS

Patients reported their medical history at baseline. They underwent ocular surface examinations and symptom evaluation using standardized protocols at baseline, 6 months, and 12 months. We analyzed the associations of systemic conditions (a systemic disease or smoking history) reported as potential DED risk factors with the severity of DED signs and symptoms using generalized linear regression models adjusted by age, gender, race, and visit.

MAIN OUTCOME MEASURES

Dry eye disease symptoms assessed using the Ocular Surface Disease Index (OSDI), 6 DED signs (tear film break-up time, anesthetized Schirmer testing, corneal fluorescein staining, conjunctival lissamine green staining, tear osmolarity, and meibomian gland dysfunction), and a composite signs severity score from 0 to 1 (1 = most severe).

RESULTS

The mean age was 58 years; 81% were women. More severe DED signs were associated significantly with Sjögren syndrome (mean composite signs severity score 0.52 with disease vs. 0.43 without disease; P < 0.001), facial rosacea (0.47 vs. 0.43; P = 0.002), rheumatoid arthritis (0.47 vs. 0.42; P = 0.002), peripheral artery disease (0.50 vs. 0.43; P < 0.001), and daily smoking history (0.45 vs. 0.43; P = 0.047). Thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, and hypertriglyceridemia were not associated significantly with DED signs. No conditions were associated significantly with OSDI.

CONCLUSIONS

In this large, well-characterized cohort of patients with DED assessed under standardized procedures, patients with certain systemic diseases and smoking history showed more severe DED signs compared with patients without the conditions. The profile of significant DED signs varied by systemic condition, reflecting different DED causes. Understanding the systemic conditions and underlying causes that predispose some patients to severe DED can improve management.

Cigarette Smoke Triggers Loss of Corneal Endothelial Cells and Disruption of Descemet's Membrane Proteins in Mice

Purpose

To investigate changes at a molecular level in the mouse corneal endothelium (CE) exposed to chronic cigarette smoke (CS).

Methods

Pregnant mice (gestation days 18–20) were placed in a whole-body exposure smoking chamber, and a few days later pups were born. After 3.5 months of CS exposure, a ConfoScan4 scanning microscope was used to examine the corneal endothelial cells (CECs) of CS-exposed and control (Ct) mice. The CE was peeled under a microscope and maintained as four biological replicates (two male and two female) for CS-exposed and Ct mice; each replicate consisted of 16 CEs. The proteome of the CE was investigated through mass spectrometry.

Results

The CE images of CS-exposed and Ct mice revealed a difference in the shape of CECs accompanied by a nearly 10% decrease in CEC density (P < 0.00003) following CS exposure. Proteome profiling identified a total of 524 proteins exhibiting statistically significant changes in CE from CS-exposed mice. Importantly, proteins associated with Descemet's membrane (DM), including COL4α1, COL4α2, COL4α3, COL4α4, COL4α5, COL4α6, COL8α1, COL8α2, and FN1, among others, exhibited diminished protein levels in the CE of CS-exposed mice.

Conclusions

Our data confirm that exposure to CS results in reduced CEC density accompanied by diminished levels of multiple collagen and extracellular matrix proteins associated with DM.

The Influence of Work Environment Factors on the OcularSurface in a One-Year Follow-Up Prospective Clinical Study

The purpose of this study was to assess the effect of environmental working conditions on the symptoms and signs of dry eye disease and to examine whether and how those conditions impact the ocular surface. Methods: This single-center, prospective clinical study with a 1-year follow-up included 150 patients. The following parameters were evaluated: non-invasive keratograph break-up time (NIKBUT), tear meniscus height (TMH), and conjunctival and limbal hyperemia. We also performed staining of the surface of the eye for simulated fluorescein images, Schirmer’s test I, assessment of Meibomian gland dysfunction (MGD), and an Ocular Surface Disease Index (OSDI) questionnaire. Results: In the OW (office workers) group, in people working >4 h at the computer, the NIKBUT before work and the Schirmer test results were statistically significantly lower than in people working <4 h. The conjunctival hyperemia result before work was statistically significantly higher for people working >4 h at a computer in both groups and after work in the MW (medical workers) group. Low relative air humidity in the building and air-conditioned rooms negatively affects the tear film, causing the symptoms of dry eye disease. At the 1-year follow-up, there was a statistically significant reduction in conjunctival and limbal hyperemia in the OW group as well as a statistically significant reduction in TMH at the first examination before and after work, and in the second examination after 1 year in both groups. Conclusions: Environmental factors such as reduced relative air humidity, increased air temperature, and decreased illumination have a negative impact on the ocular surface.

Illicit drugs: Effects on eye

There is a myriad of changes that can be produced in the eye by toxic drugs ranging from mild/no symptoms to severe loss of vision from endophthalmitis. The routes of administration include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces. It is important to recognize certain clinical signs and symptoms in the eye produced by these toxins. This article describes in brief some of the ocular effects of commonly abused drugs. For identification of a particular poisoning, in addition to the clinical presentation, pulse, blood pressure, respiration and body temperature, pupillary size, pupillary reaction to light, ocular convergence and nystagmus can be useful indicators of the type of drug the patient is exposed to. Unmasking these features help the clinician in an early and accurate diagnosis of the offending drug as well as timely management.

Prevalence and associated risk factors of dry eye disease in 16 northern West bank towns in Palestine: a cross-sectional study

Background

Dry Eye Disease (DED) is a multifactorial disease of the interpalpebral ocular surface and tear film that leads to discomfort, fatigue and disturbance in vision. DED affects patients’ quality of life and leads eventually to decrease of productivity. Moreover, it has a considerable socioeconomic burden. It is a growing underdiagnosed health issue and the possible associated risk factors are very common and keep growing worldwide.

Purpose

To assess the prevalence of DED and potential associated risk factors in the Northern West Bank of Palestine.

Methods

A cross sectional study was conducted in 16 selected towns in Northern West Bank governorates during December 2016 to September 2017. An interviewer-assisted Ocular Surface Disease Index (OSDI) questionnaire was used to study DED symptoms in the study population. Further evaluation of clinical signs of DED was performed using the following objective tests: tear film break-up time (TBUT), fluorescein corneal staining (FL/S) and Schirmer test. Subjects with an OSDI score of 13 or above were considered symptomatic of DED, and DED was defined if an OSDI score ≥ 13 is accompanied by at least one of the following signs in the worse eye: TBUT ≤10 s, Schirmer score ≤ 5 mm and fluorescein corneal staining ≥ grade 1.

Results

Seven hundred sixty-nine subjects were recruited from the general non-clinical population in the West Bank. The mean age of participants was 43.61 ± 18.57 years ranging from 18 to 90 years. Females constitute 52.7% of the study population. Based on the diagnostic criteria, the prevalence of DED was 64% (95% confidence interval 60.6–67.3). DED was significantly associated with female gender p = (0.001) and older age p = (0.001).

Conclusion

The prevalence of DED is high in the study population. Older age and female gender were associated risk factors with the development of DED.

Associations with Corneal Hysteresis in a Population Cohort: Results from 96 010 UK Biobank Participants

PURPOSE

To describe the distribution of corneal hysteresis (CH) in a large cohort and explore its associated factors and possible clinical applications.

DESIGN

Cross-sectional study within the UK Biobank, a large cohort study in the United Kingdom.

PARTICIPANTS

We analyzed CH data from 93 345 eligible participants in the UK Biobank cohort, aged 40 to 69 years.

METHODS

All analyses were performed using left eye data. Linear regression models were used to evaluate associations between CH and demographic, lifestyle, ocular, and systemic variables. Piecewise logistic regression models were used to explore the relationship between self-reported glaucoma and CH.

MAIN OUTCOME MEASURES

Corneal hysteresis (mmHg).

RESULTS

The mean CH was 10.6 mmHg (10.4 mmHg in male and 10.8 mmHg in female participants). After adjusting for covariables, CH was significantly negatively associated with male sex, age, black ethnicity, self-reported glaucoma, diastolic blood pressure, and height. Corneal hysteresis was significantly positively associated with smoking, hyperopia, diabetes, systemic lupus erythematosus (SLE), greater deprivation (Townsend index), and Goldmann-correlated intraocular pressure (IOPg). Self-reported glaucoma and CH were significantly associated when CH was less than 10.1 mmHg (odds ratio, 0.86; 95% confidence interval, 0.79-0.94 per mmHg CH increase) after adjusting for covariables. When CH exceeded 10.1 mmHg, there was no significant association between CH and self-reported glaucoma.

CONCLUSIONS

In our analyses, CH was significantly associated with factors including age, sex, and ethnicity, which should be taken into account when interpreting CH values. In our cohort, lower CH was significantly associated with a higher prevalence of self-reported glaucoma when CH was less than 10.1 mmHg. Corneal hysteresis may serve as a biomarker aiding glaucoma case detection.

Corneal Endothelial Cell Density and Morphology in Healthy Egyptian Eyes

Purpose

To evaluate the corneal endothelial cell density and morphology in normal Egyptian eyes.

Methods

In total, 568 healthy eyes of 568 Egyptian volunteers aged 20 to 85 years were examined using noncontact specular microscopy for the central corneal thickness (CCT), mean endothelial cell density (MCD), coefficient of variation (CV) in cell area, mean cell area (MCA), and hexagonal cell (Hex) percentage. Variables were compared between sexes and between different age groups.

Results

The mean CCT, MCD, and MCA were 514.45 ± 43.04 μm, 2647.50 ± 382.62 cells/mm², and 390.59 ± 149.94 μm², respectively. MCD and MCA showed no significant differences between men and women (P=0.171 and 0.099, respectively), whereas CV (%) and Hex (%) showed significant differences (P=0.024 and 0.015, respectively). CCT (P=0.007, r = −0.113) and MCD (P < 0.001, r = −0.357) exhibited a significant negative correlation with age, whereas CV (%) (P < 0.001, r = 0.341) and MCA (P=0.008, r = 0.111) exhibited a significant positive correlation. The mean rate of endothelial cell loss from 20 to 85 years of age was 0.3% per year.

Conclusions

Our results provide normative data for the corneal endothelium in healthy Egyptian eyes, thus increasing the knowledge base for corneal endothelial cell parameters in healthy Egyptian eyes. Furthermore, our findings can be used as baseline values for comparisons between Egyptian and other populations and for studies of the endothelial cell reserve and capacity for intraocular surgery and corneal transplantation.

How to treat Sjögren's syndrome

SS is a chronic, autoimmune disease of unknown aetiology for which there is no known curative treatment. Although dryness of the eyes and mouth are the classically described features, patients often experience drying of other mucosal surfaces and systemic manifestations, including fatigue and arthralgia. There is an association with other autoimmune diseases, especially thyroid disease, coeliac disease and primary biliary cholangitis. Systemic features may affect up to 70% and include inflammatory arthritis, skin involvement, haematological abnormalities, neuropathies, interstitial lung disease and a 5-10% lifetime risk of B cell lymphoma. Treatment should aim to empower patients to manage their condition; conserve, replace and stimulate secretions; prevent damage; and suppress underlying systemic disease activity.

Cumulative Effects of Smoking and Diabetes Mellitus on Corneal Endothelial Cell Parameters

PURPOSE

To compare the corneal endothelial morphometric properties and central corneal thickness (CCT) values in patients with diabetes mellitus (DM) and age-matched healthy subjects and to determine whether smoking increases the effects of DM on these corneal parameters.

METHODS

This prospective study included patients with type 2 DM and their age-matched controls. The smoking history of all participants was evaluated. Corneal endothelial cell properties including endothelial cell density (ECD), average cell area (AVG), coefficient of variation of cell area (CV), and percentage of hexagonal cells (HEX) were obtained using a noncontact specular microscope. Consequently, CCT was measured using an ultrasound pachymeter.

RESULTS

This research analyzed 153 subjects in the DM group and 146 subjects in the control group. There were no statistically significant differences in the age, sex, and smoking status of the participants in 2 groups (P > 0.05). The corneal endothelial cell measurements including ECD, AVG, CV, and HEX did not show any statistically significant differences between these groups (P > 0.05). However, CCT of patients with DM was statistically significantly thicker than that of the controls (P = 0.005). The ECD values of the smokers with DM (2435 ± 325 cells/mm) were statistically significantly lower than those of nonsmoker healthy subjects (2559 ± 279 cells/mm P = 0.008). However, the AVG, CV, HEX, and CCT values of the smokers with DM were not statistically significantly different compared with nonsmoker healthy subjects (P > 0.05).

CONCLUSIONS

Although neither only DM nor only smoking has a statistically significant effect on corneal endothelial morphometric properties, coexistence of DM and smoking causes a significant decrease in ECD.

Endothelial parameters in central and peripheral cornea in patients wearing contact lenses

AIM

To measure the parameters of endothelium in the central and peripheral parts of the cornea and evaluate the influence of wearing the hard and soft contact lenses on the mentioned parameters.

METHODS

A specular microscope was used to measure the corneal endothelium parameters in both eyes of 139 Caucasians (a total of 278). All participants were divided into three groups: soft lens wearers, hard lens wearers and a control group. Factors, such as age, smoking, types of lens material, duration of lens wear and lens air permeability were assessed to determine their impact on the morphometric parameters of the endothelium.

RESULTS

A lower percentage of hexagon-like cells and higher cell variation than in other groups were determined in hard contact lens wearers. The difference in density of endotheliocytes between the groups was not observed. The measurements of the morphometric parameters in soft contact lens wearers did not depend neither on the duration of lens wear, nor on air permeability. The relation between the patients' age and the variation of endothelium parameters was determined in the group of hard contact lens wearers.

CONCLUSION

Wearing hard contact lenses provokes pleomorphism and polymegethism of the corneal endothelium, while soft contact lenses do not impact any parameters of the endothelium, most likely due to higher air permeability.

Impact of Smoking on the Ocular Surface, Tear Function, and Tear Osmolarity

PURPOSE

This study evaluated the effects of cigarette smoking on the ocular surface, tear function, and tear osmolarity.

MATERIALS AND METHODS

A total of 50 smokers with at least 5 years of heavy smoking (defined as 1 pack/day) and 51 nonsmoking, healthy individuals were enrolled. Tear osmolarity was measured with an osmometer (TearLab^™ Osmolarity System). Ocular surface examinations involved corneal fluorescein staining, measurement of the tear film breakup time (TBUT), the Schirmer 1 test, measurement of corneal sensitivity with a Cochet-Bonnet esthesiometer, and conjunctival impression cytology. Dry eye symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. The results were compared with those from an age and sex-matched control group. The Chi-squared and independent sample t-tests were used for statistical analyses.

RESULTS

The smokers had significantly higher tear osmolarity values (305.38 ± 9.81 vs. 301.14 ± 7.04 mOsm/L; p = 0.014) and OSDI scores (34.13 ± 16.58 vs. 18.09 ± 9.61; p < 0.001) than the healthy controls. However, the TBUT, corneal sensitivity, and goblet cell density were significantly lower in smokers compared to healthy controls, but the fluorescein staining and Schirmer 1 test results were not statistically different between the smokers and controls.

CONCLUSION

Smoking results in increased osmolarity of the tear film, which can damage the ocular surface and tear function.

Cigarette smoking and the risk of primary Sjögren's syndrome: a nested case control study

BACKGROUND

Smoking is reported to affect the risk of a number of chronic disorders, including rheumatic diseases. Previous cross-sectional studies have shown a lower frequency of smoking in patients with primary Sjögren's syndrome (pSS). The aim of this study was to investigate the impact of smoking and socioeconomic status on the risk of subsequent diagnosis of pSS in a nested case-control study.

METHOD

Participants in two large population-based health surveys who were later diagnosed with pSS were identified through linkage with the Malmö Sjögren's Syndrome Register. Matched controls were obtained from the health surveys.

RESULTS

Sixty-three patients with pSS with pre-diagnostic data from the health surveys were identified. Current smoking was associated with a significantly lower risk of later being diagnosed with pSS (odds ratio (OR) 0.3; 95% CI 0.1-0.6). Furthermore, former smoking was associated with an increased risk of subsequent pSS diagnosis (OR 4.0; 95% CI 1.8-8.8) compared to never smoking. Similar results were found in a sub-analysis of patients with reported symptom onset after inclusion in the health surveys. Socioeconomic status and levels of formal education had no significant impact on the risk of later being diagnosed with pSS.

CONCLUSION

In this nested case-control study, current smoking was associated with a reduced risk of subsequent diagnosis of pSS. In addition, former smoking was associated with an increased risk. Whether this reflects a biological effect of cigarette smoking or other mechanisms should be further investigated in future studies.

Impact of Chronic Smoking on Meibomian Gland Dysfunction

Purpose

The aim of this study was to explore the relationship between chronic cigarette smoking and meibomian gland dysfunction (MGD).

Methods

This study enrolled 322 smokers with MGD and 2067 non-smokers with MGD. All enrolled subjects were tested in the following sequence: Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), corneal fluorescein staining (CFS), Schirmer I test (SIT)and finally slit-lamp microscope examination of lid margin abnormalities, meibomian gland expression as well as meibum.

Results

Compared with the MGD patients without smoking, the MGD patients with smoking had significantly increased scores of lid margin abnormality and meibum (P<0.01 for each comparison). No significant difference was noted in OSDI, TBUT, CFS, SIT or the score of Meibomian gland expressibility between the smokers and non-smokers (P>0.05 for each comparison). In the smokers, the smoking index was significantly correlated with the scores of lid margin abnormality (Both sexes, R = 0.19, P<0.01; Male, R = 0.18, P<0.01) and meibum (Both sexes, R = 0.29, P<0.01; Male, R = 0.20, P<0.01), whereas it was not significantly correlated with OSDI, TBUT, CFS, SIT or score of Meibomian gland expressibility (P>0.05 for each comparison).

Conclusion

The findings of this study suggest chronic smoking might be associated with MGD.

Assessment of Tear Film Quality among Smokers Using Tear Ferning Patterns

Purpose. To investigate the effect of cigarette smoking on the ocular tear film. Methods. Thirty healthy young male cigarette smokers (20–38 years old) and 30 healthy age matched nonsmokers were enrolled in the study. McMonnies questionnaire, slit lamp, and PRT test were used to screen the subjects. Tear samples were collected from the right eyes and tear ferning patterns were observed and graded. Results. The mean MacMonnies scores and TF grades were significantly higher in the smoker subjects (mean ± SD = 9.83 ± 5.22 and 0.96 ± 0.54, resp.) compared to nonsmokers (mean ± SD = 5.96 ± 3.06 and 0.41 ± 0.38, resp.). The mean values obtained from PRT and TBUT tests were 22.23 ± 6.35 mm and 12.17 ± 3.81 s for smokers and 22.16 ± 5.63 mm and 14.13 ± 2.62 s for nonsmokers, respectively. Strong correlations were found between MacMonnies scores and both PRT (r = 0.596) and TF (r = 0.516). There was statistically significant difference in TF grades (p = 0.00), TBUT (p = 0.036) and McMonnies (p = 0.02) between smokers and nonsmokers. Conclusion. Cigarette smoking could have a significant effect on the tear film quality of the eye.

Smoking and the risk of dry eye: a Meta-analysis

AIM

To collect the evidence to estimate the correlation between smoking and the incidence of dry eye.

METHODS

The PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL, last issue), CBM (Chinese BioMedical Literature Database), and CNKI (China National Knowledge Infrastructure/Chinese Academic Journals full-text Database) were searched for eligible studies published from January 1964 to December 2015 to investigate the association of smoking with the risk of dry eye. The odds ratio (OR) and 95% confidence interval (CI) were summarized and calculated. The extracted studies were pooled by the fixed-effects model or a random-effects model.

RESULTS

Two cohort studies and eight cross-sectional surveys were included in our Meta-analysis. There was no statistically significant relationship between current (OR=1.32; 95% CI: 0.99-1.76; P=0.055) or ever smoking (OR=1.12; 95% CI: 0.98-1.28; P=0.107) and the risk of dry eye among the studies, even when age and gender were adjusted (OR=1.16; 95% CI: 0.83-1.64; P=0.383). In the sensitivity analysis in which only general population were included, the association was significant between smoking and dry eye (OR=1.50; 95% CI: 1.08-2.09; P=0.016).

CONCLUSION

This Meta-analysis suggests that smoking may associate with the risk of dry eye in general population.

Discrepancy between subjectively reported symptoms and objectively measured clinical findings in dry eye: a population based analysis

OBJECTIVE

To investigate the discrepancy between patient-reported symptoms and measured clinical findings and influencing factors in dry eye (DE).

SETTING

A population-based, cross-sectional study was performed in July-August 2007 in northeast China. The study was performed on populations originating from two rural districts that are respectively located approximately 377 and 177 km from our hospital.

PARTICIPANTS

2600 eligible residents from 1300 households were identified; valid responses were obtained from 2262 residents (mean age 48 (range 12-88) years; 926 men and 1336 women; response rate 87%).

PRIMARY OUTCOME MEASURES

Patient-reported symptoms of DE, tear film break up time (BUT) and Schirmer scores (Schirmer II).

RESULTS

Subjects with normal BUT and Schirmer scores without any DE symptoms were defined as the control group. Those with abnormal BUT and Schirmer scores and symptoms of DE were defined as the DE group. Subjects with disparities between the occurrence of DE symptoms and measured clinical findings were regarded as the discrepancy. Out of 2262 subjects, the discrepant group contained 960 subjects (42.44%) with significant difference (χ(2)=4.027, p=0.045<0.05). Factors that influenced the subjective reporting of DE symptoms included gender, smoking status, environment and age. Schirmer II test and tear film BUT values were remarkably different among control, DE and discrepant groups.

CONCLUSIONS

Development of DE can be related to many factors. It is of great importance to put forward the preclinical phase concept (patients who are symptomatic for DE and yet show no aqueous deficiency or evaporative signs) and to screen outpatients with DE-inducing features. Future interventions should focus on patients demonstrating a discrepancy between self-reported symptomology and measured clinical findings.