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    How vaping affects the ocular surface

    The safety of electronic cigarettes is still unknown despite the number of users


    Of note, however, the number of high school and middle school students using electronic cigarettes fell to 2.2 million in 2016 from 3 million in 2015, according to 2017 survey by the Centers for Disease Control and Prevention (CDC).21

    E-cigarettes and health

    Environmental concerns as well as concerns regarding non-user exposure also exist. The health impact of e-cigarettes for users and the public cannot be determined with currently available data.22 While e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive.

    Related: A new tool for managing ocular surface disease

    In response to the growing public health concern regarding the risks or benefits of e-cigarette use relative to smoking, the National Institute on Drug Abuse (NIDA) has recently introduced the first standardized and well-characterized e-cig device to the research community.23 The availability of the NIDA Standard Research e-cigarette offers a exceptional research opportunity with tremendous public health implications.

    Comparing and contrasting the cancer-causing potentials of standard vaping and smoking in youth will help determine the health risks or benefits of e-cigarette use relative to cigarette smoking. This information will be instrumental in making scientifically based decisions on the development and evaluation of policies and regulations on e-cigarette manufacture, marketing, and distribution.

    Ultimately, evidence-based guidelines and legislations on e-cigarettes may help reduce the burden of tobacco-related diseases, particularly on minors and vulnerable populations. I suspect that this work will guide investigation to vaping effects—or not—on the ocular surface.24

    A PubMed “e-cigarette dry eye/ocular surface” search in early September 2017 yielded no results. You can find a case, however, that describes extensive ocular injury secondary to an e-cigarette-related explosion. The explosion was the result of modifications made to a heating element of the e-cigarette device.25

    I eagerly await studies on this topic and until then suspect that the use of ENDS negatively impact the ocular surface environment. I am certain we will revisit this critical topic in the months to come.



    1. Blu. Vaping Glossary. Available at: https://www.blu.com/en/US/explore/explore-vaping/vaping-glossary.html. Accessed 9/4/17.

    2. Ayers JW, Leas EC, Allem JP, Benton A, Dredze M, Althouse BM, Cruz TB, Unger JB. Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015. PLoS One. 2017 Mar 1;12(3):e0170702.

    3. Gmel G, Baggio S, Mohler-Kuo M, Daeppen JB, Studer J. E-cigarette use in young Swiss men: is vaping an effective way of reducing or quitting smoking? Swiss Med Wkly. 2016 Jan 11;146:w14271.

    4. Canistro D, Vivarelli F, Cirillo S, Babot Marquillas C, Buschini A, Lazzaretti M, Marchi L, Cardenia V, Rodriguez-Estrada MT, Lodovici M, Cipriani C, Lorenzini A, Croco E, Marchionni S, Franchi P, Lucarini M, Longo V, Della Croce CM, Vornoli A, Colacci A, Vaccari M, Sapone A, Paolini M. E-cigarettes induce toxicological effects that can raise the cancer risk. Sci Rep. 2017 May 17;7(1):2028.

    5. Xu L, Zhang W, Zhu XY, Suo T, Fan XQ, Fu Y. Smoking and the risk of dry eye: a Meta-analysis. Int J Ophthalmol. 2016 Oct 18;9(10):1480-1486.

    6. Uchino Y, Uchino M, Yokoi N, Dogru M, Kawashima M, Komuro A, Sonomura Y, Kato H, Argüeso P, Kinoshita S, Tsubota K. Impact of Cigarette Smoking on Tear Function and Correlation between Conjunctival Goblet Cells and Tear MUC5AC Concentration in Office Workers. Sci Rep. 2016 Jun 14;6:27699.

    7. Matsumoto Y, Dogru M, Goto E, Sasaki Y, Inoue H, Saito I, Shimazaki J, Tsubota K. Alterations of the tear film and ocular surface health in chronic smokers. Eye (Lond). 2008 Jul;22(7):961-8.

    8. National Cancer Institute. Secondhand Smoke and Cancer. at: http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS. Accessed 9/24/17. Available

    9. Rummenie VT, Matsumoto Y, Dogru M, Wang Y, Hu Y, Ward SK, Igarashi A, Wakamatsu T, Ibrahim O, Goto E, Luyten G, Inoue H, Saito I, Shimazaki J, Tsubota K.Tear cytokine and ocular surface alterations following brief passive cigarette smoke exposure. Cytokine. 2008 Aug;43(2):200-8.

    10. Ward SK, Dogru M, Wakamatsu T, Ibrahim O, Matsumoto Y, Kojima T, Sato EA, Ogawa J, Schnider C, Negishi K, Tsubota K. Passive cigarette smoke exposure and soft contact lens wear. Optom Vis Sci. 2010 May;87(5):367-72.

    11. El-Shazly AA, El-Zawahry WM, Hamdy AM, Ahmed MB.  Passive smoking as a risk factor of dry eye in children. J Ophthalmol. 2012;2012:130159.

    12. Hays JT. What is thirdhand smoke, and why is it a concern? Mayo Clinic. Available at: http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-2005779. Accessed 9/5/2017

    13. Logue JM, Sleiman M, Montesinos VN, Russell ML, Litter MI, Benowitz NL, Gundel LA, Destaillats H. Emissions from Electronic Cigarettes: Assessing Vapers' Intake of Toxic Compounds, Secondhand Exposures, and the Associated Health Impacts. Environ Sci Technol. 2017 Aug 15;51(16):9271-9279.

    14. Farsalinos KE, Voudris V, Poulas K. E-cigarettes generate high levels of aldehydes only in 'dry puff' conditions. Addiction. 2015 Aug;110(8):1352-6.

    15. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control. 2014 May;23 Suppl 2:ii11-7.

    16. Electronic cigarettes (e-cigarettes) dollar sales worldwide from 2008 to 2017 (in million U.S. dollars). Statista. Available at: https://www.statista.com/statistics/493214/global-e-cigarettes-dollar-sales/. Accessed 9/4/2017.

    17. Greenhill R, Dawkins L, Notley C, Finn MD, Turner JJ. Adolescent Awareness and Use of Electronic Cigarettes: A Review of Emerging Trends and Findings. J Adolesc Health. 2016 Dec;59(6):612-619.

    18. Young-Wolff KC, Klebaner D, Folck B, Carter-Harris L, Salloum RG, Prochaska JJ, Fogelberg R, Tan ASL. Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults. Prev Med. 2017 Aug 16;105:32-36.

    19. Krishnan-Sarin S, Morean M, Kong G, Bold KW, Camenga DR, Cavallo DA, Simon P, Wu R. E-Cigarettes and "Dripping" Among High-School Youth. Pediatrics. 2017 Mar;139(3). pii: e20163224.

    20. Pepper JK, Lee YO, Watson KA, Kim AE, Nonnemaker JM, Farrelly MC. Risk Factors for Youth E-Cigarette "Vape Trick" Behavior. Adolesc Health. 2017 Jun 29. pii: S1054-139X(17)30215-X.

    21. New Surveys Suggest Teen Vaping Rates Falling. NY Times. Available at: https://www.nytimes.com/2017/06/19/health/teen-vaping.html. Accessed 9/4/2017.

    22. Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control. 2014 May;23 Suppl 2:ii36-40.

    23. National Institute on Drug Abuse. Supplemental Information for NIDA e-cig. Available at: https://www.drugabuse.gov/funding/supplemental-information-nida-e-cig. Accessed 9/24/17.

    24. Besaratinia A, Tommasi S. An opportune and unique research to evaluate the public health impact of electronic cigarettes. Cancer Causes Control. 2017 Aug 31. doi: 10.1007/s10552-017-0952-5.

    25. Khairudin MN, Mohd Zahidin AZ, Bastion ML. Front to back ocular injury from a vaping-related explosion. BMJ Case Rep. 2016 Apr 5;2016. pii: bcr2016214964.

    Read more from Dr. Mastrota here

    Katherine M. Mastrota, MS, OD, FAAO, Dipl ABO
    Director of Optometry, New York Hotel Trades Council, Hotel Association of New York City, Health Center, Inc.


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