With a series of hospitalizations and even a few deaths linked to vaping, the use of e-cigarettes is under renewed scrutiny.1 The Centers for Disease Control points to approximately 530 cases of acute lung injury across 38 states and one US territory that often involved a life-threatening build up of fluid in the lungs.1 The epidemic has even led to a federal criminal investigation and prompted the CEO of one of the major manufacturers of e-cigarettes—Juul—to step down.2,3 But, new research is showing the harm these trendy nicotine delivery devices can inflict goes beyond the respiratory system. Vaping can aggravate the ocular surface as well and is directly connected with moderate-to-severe dry eye symptoms, according to a study published in Optometry and Vision Science.4

According to the researchers, hazardous byproducts from pyrolysis of the liquid constituents can both instigate and worsen dry eye symptoms. The team looked at 21 patients who used e-cigarettes and an additional 21 healthy nonsmokers who were all evaluated using noninvasive tear break-up time, fluorescein break-up time, ocular surface staining, tear meniscus height, Schirmer testing and the ocular surface disease index (OSDI) survey. As an additional measure, the researchers documented the effect of voltage degree used during vaping.

The OSDI scores show those who vape experience symptoms of moderate-to-severe eye dryness at a higher rate than their non-smoking counterparts. Vapers also experienced significant reductions of noninvasive tear break-up time, fluorescein break-up time and tear meniscus height compared with non-smokers. Schirmer tests showed higher results in those who used vaping products as well.

As a secondary finding, the researchers found that, even amongst vapers, those who use a greater voltage aggravated their dry eye symptoms and tear instability more than those who used lower voltage; Schirmer test results increased with voltage as well.4

“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,” the team concludes.4

1. CDC. Outbreak of lung injury associated with e-cigarette use, or vaping. Smoking & Tobacco Use. www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak-information. September 19, 2019. Accessed September 25, 2019.

2. CDC. Transcript of CDC telebriefing: update on lung injury associated with e-cigarette product use, or vaping. CDC Newsroom. www.cdc.gov/media/releases/2019/t0919-lung-inury-vaping.html. September 19, 2019. Accessed September 25, 2019.

3. Juul Labs. Juul Labs names new leadership, outlines changes to police and marketing efforts. Company News. newsroom.juul.com/2019/09/25/juul-labs-names-new-leadership-outlines-changes-to-policy-and-marketing-efforts/.  September 25, 2019. Accessed September 25, 2019.

4. Md Isa NA,  Koh PY, Doraj P. The tear function in electronic cigarette smokers. Optom Vis Sci. 2019;96(9):678-85.