Influence of Active and Passive Smoking on the Tear Film in the Saudi Population

Purpose: To investigate the effects of different types of smoking on the precorneal tear film stability and quality using questionnaire, clinical tests and noninvasive keratography. And to provide community awareness about the dangers of dry eye and its connection to smoking. Methods: Prospective cross-sectional study with a total of 33 participants was enrolled in this study. The participants’ ages ranged between 17 to 40 years old. They were divided into 3 groups: Control non smokers, Passive smokers, and Active smokers. All participants of control and passive smokers’ groups are females (100.0%), while there are (45.5%) male participants in active smokers’ group and (54.5%) females. there were no statistically significant differences between groups (non – passive - active) smokers related to spherical equivalent; p value was (0.403). All subjects replied to questionnaire for dryness evaluation then went through full ophthalmological examinations. Also, we examined subjects for dryness using clinical tests (Tear break up time TBUT and Schirmer) and non-invasive keratography. Results: Dry Eye Questionnaire analysis: all control group participants were normal and not dry. There are (54.5%) dry, while (45.5%) in passive Group were not. And participants of active smokers’ group with percentage of (54.5%) were dry, (45.5%) were not dry. As regards clinical parameters (TBUT and Shirmer): we concluded that there were no statistically significant differences between groups related to TBUT & Schirmer tests, where p value was 0.095, 0.993 respectively. Noninvasive keratograph dryness tests (TBUT & tear meniscus height TMH) we concluded that there were statistically significant differences between groups related to TBUT where p value was 0.026, with insignificant reduction of TMH values in active smoker group as P value was 0.283. Conclusion: These findings suggest that chronic smoking has a negative effect on the ocular surface and affects some tear characteristics. Moreover, the chronic ocular irritative effects of cigarette smoking may lead to defects in ocular surface defense.