Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers

Abstract

The study aimed to evaluate the ocular surface and meibomian gland morphology in electronic cigarette (e-cigarette) smokers. Methods: The upper and lower eyelids of 25 male e-cigarette smokers and 25 healthy male non-smoker patients were evaluated using Sirius meibography. Meibomian glands loss was automatically calculated using Phoenix meibography imaging software module, with the result obtained as percentage loss. Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time test, and Schirmer II test were administered and performed in all cases. Results:The mean e-cigarette smoking duration was 4.9 ± 0.9 (range, 3.4-7) years. While the mean Schirmer II test value was 9.16 ± 2.09 mm in e-cigarette group, it was 11.20 ± 2.14 mm in control group (p=0.003). Mean tear breakup time was 6.96 ± 2.31 seconds in e-cigarette group and 9.84 ± 2.13 seconds in control group (p=0.002). The mean OSDI value was 28.60 ± 6.54 and 15.16 ± 7.23 in e-cigarette and control groups, respectively (p<0.001). In Sirius meibography, the average loss for the upper eyelid was 23.08% ± 6.55% in e-cigarette group and 17.60% ± 4.94% in control group (p=0.002), and the average loss for the lower eyelid was 27.84% ± 5.98% and 18.44% ± 5.91%, respectively (p<0.001). Additionally, a significant positive correlation was identified between the loss rates for both upper and lower eyelid meibography with e-cigarette smoking duration (r=0.348, p<0.013 and r=0.550, p<0.001, respectively). Conclusion:Long-term e-cigarette smoking causes damage to the meibomian glands; therefore, meibomian gland damage should be considered in ocular surface disorders due to e-cigarette smoking.

The Impact of Vaping on the Ocular Surface: A Systematic Review of the Literature

“…This increase in tear production may be a potential homeostatic measure in response to lower tear film integrity that may result from e-cig use. In contrast, Kalayci et al [29] found that the average Schirmer II values were significantly (p = 0.002) lower in the e-cig group at 9.16 ± 2.09 mm compared to the control group at 11.2 mm ± 2.14 mm, which was attributed to the impact that the metabolites of lipid peroxidation (i.e., malondialdehyde) associated with e-cig use have on the ocular surface.…”

“…Their study found that participants in the e-cig group had a significant (p = 0.002) average meibomian gland loss of 23.08 ± 6.55% on the upper eyelid and a significant (p < 0.001) average meibomian gland loss of 27.83 ± 5.98% on the lower eyelid compared to the controls who had an average loss of 17.60 ± 4.94% and 18.44 ± 5.91%, respectively. Moreover, e-cig users were more likely to have Meibomian glands that were irregularly distributed and less hyperreflective compared to the control group [29].…”

“…Ocular surface malignancies, changes in tear film stability and quality, tear production, corneal epithelial thickness, average loss of meibomian glands in the upper and lower eyelid, and dry eye symptoms/ocular irritation have been associated with chronic exposure to e-cig use [11,28,29]. An earlier comprehensive review carried out by Makrynioti et al [11] described the impact that various forms of smoking, such as combustible cigarettes and e-cigs, had on dry eye and various ocular conditions.…”

“…Moreover, a systematic review conducted by Miglio et al [31] revealed that e-cigs could negatively impact both the stability and quality of the tear film. Kalayci et al [29] conducted a cross-sectional study comparing the ocular surface of people who used and did not use e-cigs (control). Tear breakup time (TBUT) was evaluated with the assistance of a biomicroscope, and e-cig users had a significantly lower TBUT of 6.96 ± 2.31 s compared to 9.84 ± 2.13 s for the control group [29].…”

“…Furthermore, Kalayci et al [29] conducted non-contact meibography to evaluate the impact of e-cig use on the meibomian glands over an average duration of 4.9 years. The loss of meibomian glands was calculated using the Phoenix meibography imaging software module installed on the Sirius (CSO, Florence, Italy) corneal topography device.…”