Dry Eye Dx and Tx

Do E-Cigarettes Impact Dry Eye and Ocular Surface Disease?

Dry Eye Dx and Tx

Do E-Cigarettes Impact Dry Eye and Ocular Surface Disease?


My father began smoking unfiltered tobacco cigarettes at age 16. When he was 49, he died of lung cancer. My brother started smoking in college; he quit and restarted so many times that I’ve lost count. Aside from the well-documented negative impact on health attributed to cigarette smoking, you can understand why I have a problem with the habit.

And then one day I received an email with a subject line that read “You Are One of the Select Few Chosen to Try the Electronic Cigarette.” How did I become one of the select few? Was my 17-year-old daughter also selected? My brother? What is an electronic cigarette?

An electronic cigarette (e-cig, e-cigarette) or electronic nicotine delivery system (ENDS) is a battery-powered vaporizer that simulates tobacco smoking. E-cigarettes and “vape” pens are similar devices but are so called because of the specific vaporizing materials associated with each; e-cigarettes are marketed specifically for “e-juices” that usually contain nicotine and can function and mimic the look and feel of real cigarettes. These products are currently unregulated by the U.S. Food and Drug Administration.

In 2013, e-cigarettes represented a $1.7 billion industry (Mangan, 2013). They are readily available for purchase in storefronts and even online (traditional cigarette shipments are regulated). Rates of e-cig use in teens rose from 4.7% in 2011 to 10% in 2012 (Centers for Disease Control and Prevention [CDC], 2014). A recent study of 1,900 young high-schoolers in Hawaii shows that 29% have tried e-cigarettes (Wills et al, 2015). “There is cause for concern for this alarming increase in teenage use of e-cigs,” said CDC Director Tom Frieden, MD, MPH. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

“About 90% of all smokers begin smoking as teenagers,” added Tim McAfee, MD, MPH, director of the CDC Office on Smoking and Health.

Eye Health Concerns

Tobacco smoking, as we all are aware, is detrimental to overall health and is associated with ocular surface disease. What about the use of e-cigarettes? E-cigarettes do not contain tobacco, although they do use nicotine from tobacco plants. They do not generate cigarette smoke, but rather an aerosol (which is a suspension of fine particles of liquid, solid, or both in a gas; both the particulate and gas phases are mixtures of chemical substances in e-cigarette aerosols) (Cheng, 2014) that is frequently but inaccurately referred to as vapor (a vapor is a substance in the gas phase).

Environmental concerns and issues regarding non-user exposure also exist. The health impact of e-cigarettes, for users and for the public, however, cannot be determined with currently available data (Callahan-Lyon, 2014).

Scientific evidence regarding the human health effects of e-cigarettes is limited. While e-cigarette aerosol may contain fewer toxicants compared to cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive.

A PubMed “e-cigarette dry eye/ocular surface” search in December 2014 yielded no results. I eagerly await studies on this topic. Until then, I suspect that the use of ENDSs negatively impacts the ocular surface environment. I will likely revisit this critical issue in the months to come. CLS

For references, please visit and click on document #232.

Dr. Mastrota is secretary of the Anterior Segment Section of the American Academy of Optometry. She is a consultant or advisor to Allergan, B+L, BioTissue, Nicox, NovaBay Pharmaceuticals, and OcuSoft and is a stock shareholder of TearLab Corporation. Contact her at