Adolescent users of both e-cigarettes and cigarettes more likely to have ocular symptoms

By Melanie Hinze

Severe and frequent ocular symptoms are more likely in adolescent and young adult users of both electronic cigarettes (e-cigarettes) and cigarettes than in young people who use only one of the products or don’t use them at all, according to research published in JAMA Ophthalmology.

The observational, cross-sectional study involved 4351 US individuals aged 13 to 24 years (63.8% female; mean age 19.1 years) who were surveyed about their e-cigarette and cigarette use in the past seven days, 30 days and ever.

Overall, 2168 participants were never users of cigarettes or e-cigarettes, 2183 were ever users, 1092 were past 30-day users and 919 were past seven-day users. Among those who had ever used e-cigarettes, 55.9% had also used cigarettes, making them dual users.

Participants who were dual users in the past seven days reported more severe itching, redness, dryness, glare, blurriness and headaches than all other participants. They also reported more frequent pain, burning and redness than all other participants. Past 30-day dual users had more severe dryness and more frequent pain than all other participants.

Dual users who had ever used cigarettes or e-cigarettes reported more severe dryness and blurriness and more frequent pain and blurriness than those who had never used these products.

Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms, and 0.9% to 4.3% reported daily symptoms.

The authors also found that those who had only used e-cigarettes were most worried about their eyesight.

‘These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms,’ the authors wrote.

Associate Professor Chameen Samarawickrama, NHMRC Investigator Fellow with Westmead Institute for Medical Research, and Head of the Translational Ocular Research and Immunology Consortium (TORIC), Sydney, said this was an interesting study that appeared to show that young participants who smoked cigarettes, e-cigarettes, or both, had an increase in dry eye symptoms and anxiety about their eyes compared with those who did not.

Associate Professor Samarawickrama, who is also a cornea subspecialist at Westmead Hospital, Sydney, said, ‘In ophthalmology we are seeing an increase in dry eye disease, particularly meibomian gland disease, which is one of the most common types of dry eye.’

‘In many ways this reflects the modern lifestyle, with high levels of phone and screen use, increased exposure to air-conditioning and time spent indoors,’ he said. ‘It also matches the increase in young person anxiety reported in the literature and media,’ he added.

‘This study wasn’t designed to look at correlations, but I wonder if those who are more anxious are more likely to try cigarettes or e-cigarettes, and with that experience more severe dry eye symptoms,’ he noted.

JAMA Ophthalmol 2023; doi: 10.1001/jamaophthalmol.2023.3852.