Dry eye disease and retinal nerve fiber layer changes in chronic smokers

Indian J Ophthalmol. 2021 May;69(5):1178-1182. doi: 10.4103/ijo.IJO_976_20.


Purpose: To study the effect of smoking on tear film parameters and retinal nerve fiber layer thickness (RNFL) in chronic smokers.

Methods: This was a cross-sectional study, which included 60 (120 eyes) smokers who have smoked at least 10 pack-year and an equal number of healthy subjects as a control for comparison. In addition to history, a detailed slit-lamp examination was done to evaluate the anterior and posterior segments. All patients underwent Schirmer's I test (SIT) with Whatman-41 filter paper, tear meniscus height (TMH), and RNFL with a Fourier-domain optical coherence tomography (OCT) and tear film breakup time (TBUT) with 2% fluorescein and cobalt blue filter using slit-lamp biomicroscopy.

Results: The (mean ± SD) age of the participants was 56.48 ± 10.38 years. There was a statistically significant reduction in tear film parameters in smokers compared to nonsmokers (P = 0.000). The incidence of MGD was found to be higher in smokers when compared to nonsmokers with a P value of 0.000. RNFL in all four quadrants was also significantly reduced in smokers compared to nonsmokers (P = 0.00).

Conclusion: This study shows that chronic smoking leads to an increased incidence of dry eye disease and is associated with RNFL thinning. Smoking can result in cumulative RNFL loss in patients with ocular neurodegenerative disorder and OCT of these patients may have to be interpreted keeping this in mind.

Keywords: Chronic smokers; pack-year; retinal nerve fiber layer thickness; tear film parameters.

MeSH terms

  • Aged
  • Cross-Sectional Studies
  • Dry Eye Syndromes* / diagnosis
  • Dry Eye Syndromes* / epidemiology
  • Dry Eye Syndromes* / etiology
  • Humans
  • Middle Aged
  • Nerve Fibers
  • Smokers*
  • Smoking / adverse effects
  • Tomography, Optical Coherence