Smoke Gets In Your Eyes
Muriel Schornack, OD, FAAO
Abstract:
Most patients are aware of smokers’ increased risk of cardiovascular and pulmonary disease, but many do not know that smoking has also been associated with increased risk for ocular pathology. This course will review ocular conditions associated with smoking, and will examine mechanisms by which toxins in tobacco smoke can damage ocular tissue.
Learning Objectives:
1. Participants will be able to identify potentially damaging effects of tobacco products on various ocular tissues.
2. Participants will demonstrate an understanding of the mechanisms by which damage to ocular tissue can occur.
3. Participants will be prepared to discuss potential benefits of cessation with patients who smoke.
Key words: Public Health, Age-related eye disease, Tears/Dry eye/Lacrimal system
1) Background a) Prevalence of smoking in the United States i) Adults ii) Youth b) Public perception of health risks associated with smoking i) Adults ii) Youth c) Summary i) While smoking is associated with an increased risk of a number of ocular diseases, the public is not well-informed of these risks. ii) Loss of vision is considered as serious as cardiovascular and pulmonary disease by many people. iii) The association between ocular disease and smoking could be a powerful incentive for cessation for patients who smoke.
2) Smoking and Anterior Segment Disease a) Smoking and Ocular Surface Disease i) Increased prevalence of “dry eye” symptoms in active and passive smokers ii) Decreased lysozyme density iii) Decreased stability of the lipid layer iv) Decreased tear break-up time b) Smoking and the Conjunctiva i) Increased irritation ii) Increased injection iii) Decreased conjunctival sensitivity iv) Increased squamous metaplasia

c) Smoking and the Cornea i) Decreased corneal sensation ii) Increased risk of contact lens-related corneal infiltrative events d) Pathogenesis of Smoking-Related Anterior Segment Pathology i) Irritation from airborne toxins ii) Decreased lipid quality iii) Altered tear film composition iv) Toxic inflammatory stimuli
3) Smoking and Thyroid Disease a) Clinical Findings i) Increased risk of thyroid-associated ophthalmopathy (TAO) ii) Increased severity of TAO compared to non-smokers iii) Delayed response to treatment iv) Decreased response to treatment b) Pathogenesis i) Inhibition of iodine uptake and hormone synthesis ii) Effects on sympathetic nervous system iii) Changes in TSH and thyroglobulin levels iv) Hypoxic contribution to muscular inflammation
4) Smoking and Cataracts a) Clinical Findings i) Increased risk of nuclear cataracts ii) Potentially increased risk of posterior subcapsular opacities iii) Increased likelihood of cataract extraction iv) Increased risks are dose-related b) Pathogenesis i) Oxidative damage to lens fibers ii) Deposition of heavy metals within the lens
5) Smoking and Ocular Ischemia a) Clinical Findings i) Increased risk of amaurosis fugax ii) Increased risk of retinal infarction iii) Increased risk of AION b) Pathogenesis i) Increased blood viscosity ii) Vasoconstriction iii) Decreased oxygen capacity of hemoglobin iv) Increased severity of atherosclerosis
6) Smoking and Macular Degeneration a) Clinical Findings i) Increased risk of AMD ii) Increased risk of exudative AMD iii) Increased risk of recurrence of exudative AMD after laser photocoagulation iv) Past smokers may have increased risk compared to patients who have never smoked

b) Pathogenesis i) Retinal ischemia, hypoxia, micro infarctions ii) Reduced plasma concentration of antioxidants iii) Lipid abnormalities
7) Smoking and Other Ocular Diseases a) Strabismus (in infants with prenatal tobacco exposure) b) Optic neuropathy c) Glaucoma
8) Conclusion a) Ask your patients if they smoke b) Make them aware of the increased risks of ocular disease associated with smoking c) Encourage patients who smoke to consider cessation d) Encourage young patients who do not smoke to continue with a smokefree lifestyle.

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