Abstract
To find out an association, if any, between smoking and dry eye diseases and whether it has any relation to the number of cigarettes smoked. Patients attending the hospital outpatient department were enquired about smoking and then given the option to enrol in the study following a written and informed consent. Depending on the number of cigarettes they smoked, patients were divided in three groups, namely low, moderate and high smokers based on the heaviness of Smoking Index. They were labelled as Group A, B and C respectively. Symptomatic assessment of each group was done by the Ocular Surface Disease Index (OSDI) questionnaire, and a score greater than 12 was considered meaningful. Clinical evaluation was done by performing TBUT and Schirmer’s test. Respective cut off values were 10 seconds and 10 mm. Deviations from established normal values were observed and analyzed. A total of 205 patients participated in this study of which 90.7% (n= 186) were males and 9.3% (n= 19) were females. 30.7% (n= 63) patients were low smokers (Group A), 42.9% (n= 88) were moderate smokers (Group B) and 26.3% (n= 54) were high smokers (Group C). The mean TBUT and OSDI scores showed progressive deterioration from Group A to C, whereas the mean Schirmer’s values across all groups remained relatively unaffected. Cigarette smoking had a deleterious effect on the health of the ocular surface, but the aqueous tear secretion remained unaffected.
Highlights
Dry eye syndrome reffers to a situation where the normal health of the ocular surface is adversely affected due to disturbance of one or more components of the pre corneal tear film
While the Schirmer’s test focuses on the status of the aqueous tear secretion, the tear film break up time (TBUT) quantifies the overall stability of the pre corneal tear film, which is again dependent on the integrity of the outermost lipid layer of the aforesaid structure. 6
We found an increase in mean Ocular Surface Disease Index (OSDI) scores form Group A through Group C, implying worsening of dry eye symptom as the number of cigarette intake increased
Summary
Dry eye syndrome reffers to a situation where the normal health of the ocular surface is adversely affected due to disturbance of one or more components of the pre corneal tear film. The proximal or mucin layer is secreted mostly by the goblet cells and the accessory mucin secretors namely the crypts of Henle and the glands of Manz. Sparsenes of this layer, as happens for example in Vitamin A deficiency, can cause ocular dryness even in the presence of adequate aqueous tear secretion. The most distal of the three layers - - the lipid layer is secreted mainly by the mebomian glands and is entrusted with providing vertical stability to the pre corneal tear film and preventing its evaporative loss. In mebomian gland dysfunction (MGD), the functionality of the lipid layer is affected, leading to quicker evaporation of the aqueous layer thereby causing dryness of the ocular surface
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