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

ABSTRACT

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.

KEYWORDS:

• Dry eye disease
• goblet cells
• Schirmer 1 test
• smoking
• tear osmolarity

Acknowledgments

This study was supported by the Dumlupinar University Scientific Research Projects Commission (Project number: 2015–73).

Conflicts of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the manuscript.