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E-cigarette use correlated with dry eye, injury potential

Raymond Chu, OD, MS, FAAO, and Yin C. Tea, OD, FAAO, presented data at the American Academy of Optometry virtual meeting that connected e-cigarette use with ocular health complications including dry eye.

Chu directed the audience to a bulletin released by the American Optometric Association that showed decreasing use of cigarettes and tobacco in the U.S.

“This is certainly a win for all health care providers, that the efforts to curb smoking are working,” said Chu, from the Southern California College of Optometry at Marshall B. Ketchum University. “However, as we drill down further into the numbers, there is an alarming trend of vaping or e-cigarette use increasing.”

While e-cigarette use and vaping has increased among all populations, he said, there is a specific concern for adolescents.

Chu quoted the CDC’s National Youth Tobacco Survey from 2011 to 2018, which showed that e-cigarette use increased from 11.7% to 20.8% among high school students and from 3.3% to 4.9% in middle school students. Additionally, the CDC reported that e-cigarette ads reach 4 out of 5 million U.S. middle and high school students.

Tea, from Nova Southeastern University, College of Optometry, Florida, clarified details of the e-cigarette anatomy, which includes a battery, sensors, atomizer and cartridge for the vaping liquid. E-cigarettes, she said, have also evolved from the “first generation” of disposable products that looked like traditional cigarettes toward the larger, modifiable versions.

“People think the e-cigarette aerosols are not as dangerous as smoke from combustible cigarettes because ‘it’s just water vapors with some nicotine.’ That may be how it’s marketed or how people perceive it, but we now know that these aerosols have unsafe chemicals.”

Tea explained that the e-cigarette liquid can contain: nicotine; volatile organic compounds; ultrafine particles; cancer-causing chemicals; heavy metals such as nickel, tin and lead; and flavoring such a diacetyl, a chemical linked to a serious lung disease.

Additionally, when the liquid is heated to a very high level, which can happen in the newer modifiable devices, the solvents are transformed into formaldehyde, a mucous-membrane irritant known to cause conjunctivitis and lacrimation.

Other complications related to the modifiable devices are potentially defective batteries or malfunctions caused by “hacking the device for a bigger hit,” Tea said. She recounted two cases of corneoscleral lacerations and ocular burns caused by e-cigarette explosions and another case in which an 18-year-old man modified his tank, leading to an explosion that propelled the device into the ride side of his face. This caused a choroidal rupture at the macula, resulting in a macular scar, and left the patient’s right eye vision at counting fingers.

“What else about ocular health? Traditional cigarettes are known to cause ocular inflammation and exacerbate certain conditions such as age-related macular degeneration, cataracts, thyroid eye disease and diabetic retinopathy, and are a risk factor for developing dry eye disease. We now know that vaping is also correlated with dry eye and general eye irritation.”

Tea quoted results from a study that showed noninvasive tear breakup time, fluorescein breakup and tear meniscus height decreased significantly in vapers vs. nonsmokers. These same effects were also correlated with use of higher voltage.

“The take-home is that there will be more signs of dry eye in vapers than in non-vapers,” she said.

Talitha Bennett/Healio