Elsevier

Survey of Ophthalmology

Volume 42, Issue 6, May–June 1998, Pages 535-547
Survey of Ophthalmology

The Association Between Cigarette Smoking and Ocular Diseases

https://doi.org/10.1016/S0039-6257(98)00002-2Get rights and content

Abstract

Tobacco smoke is composed of as many as 4,000 active compounds, most of them toxic on either acute or long-term exposure. Many of them are also poisonous to ocular tissues, affecting the eye mainly through ischemic or oxidative mechanisms. The list of ophthalmologic disorders associated with cigarette smoking continues to grow. Most chronic ocular diseases, with the possible exception of diabetic retinopathy and primary open-angle glaucoma, appear to be associated with smoking. Both cataract development and age-related macular degeneration, the leading causes of severe visual impairment and blindness, are directly accelerated by smoking. Other common ocular disorders, such as retinal ischemia, anterior ischemic optic neuropathy, and Graves ophthalmopathy, are also significantly linked to this harmful habit. Tobacco smoking is the direct cause of tobacco-alcohol amblyopia, a once common but now rare disease characterized by severe visual loss, which is probably a result of toxic optic nerve damage. Cigarette smoking is highly irritating to the conjunctival mucosa, also affecting the eyes of nonsmokers by passive exposure (secondhand smoking). The dangerous effects of smoking are transmitted through the placenta, and offspring of smoking mothers are prone to develop strabismus. Efforts should be directed toward augmenting the campaign against tobacco smoking by adding the increased risk of blindness to the better-known arguments against smoking. We should urge our patients to quit smoking, and we must make them keenly aware of the afflictions that can develop when smoke gets in our eyes. (Surv Ophthalmol 42:535–547, 1998.

Section snippets

Ocular Irritation

Large parts of the population in many countries worldwide are exposed to environmental tobacco smoke (also referred to as passive or secondhand smoking), which means that the health effects resulting from this wide-scale exposure are of great concern.105 The most common complaint of passive smokers is eye irritation, followed by cough, nose irritation, and headache.32, 83, 101 Like all other body mucosae, the conjunctival mucosa is highly sensitive to airborne chemicals, fumes, and irritative

Ocular Ischemia

This section summarizes the available clinical information on the association between tobacco consumption and ocular ischemia. The higher risk of ischemic disease in smokers can be explained by several mechanisms. Both erythrocyte and leukocyte concentrations are elevated in smokers,25, 35, 54 and platelets are activated in the blood of long-term smokers.36 These factors may contribute to hyperviscosity and an increased risk of thrombosis. There is also an increase in the clotting potential of

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is one of the leading causes of visual loss in the Western world.12, 34 It is estimated that about 30% of the population older than 75 years suffer from early stages of the disease, while the late stages affect approximately 7% of this age group.66 At the early stages of disease visual acuity is usually normal, but as the disease progresses foveal function is impaired and visual acuity is severely affected.68 The pathogenesis of AMD is poorly understood.

Cataract

Cataract is the main cause of blindness and visual impairment throughout the world. More than 15 million persons worldwide are estimated to be blind because of cataract, and as life expectancy continues to rise, the prevalence of visual impairment caused by lens opacities is expected to increase. Several authors have reported a significant link between tobacco smoking and an increased risk of cataract development.20, 47, 45, 74, 155 In a review of the literature on risk factors for the

Graves Ophthalmopathy

The pathogenic mechanism underlying Graves disease is thought to be autoimmune, although the cause is still unknown.14, 153 It seems that both genetic and environmental factors play a role in the development of this disorder,28 and smoking is probably one of the factors capable of inducing Graves disease in genetically predisposed individuals.4, 43 Among the various clinical features of Graves thyroidopathy, the ophthalmologic manifestations seem to be closely associated with smoking. Shine et

Tobacco-Alcohol Amblyopia

Tobacco-alcohol amblyopia (TAA) is a disease that mainly affects middle-aged men and is characterized by a distinct bilateral visual disturbance, symmetric scotomas usually cecocentral in position, an acquired disturbance of color vision, and fundal morphology that may be normal or characterized by tortuosity of small retinal vessels within the nerve fiber layer.41 Usually the visual acuity is severely affected,70, 71, 115 with characteristic electrophysiologic changes.1, 59, 71, 72 There is

Primary Open-Angle Glaucoma

The evidence for involvement of smoking in the pathogenesis of primary open-angle glaucoma (POAG) is controversial. While several studies have indicated that cigarette smoking is a risk factor for its development, others have failed to do so. In a case-control study using an exploratory health questionnaire, Wilson et al160 identified potential risk factors for the development of POAG in 83 patients and 121 POAG suspects. The most important factors were found to be ethnic origin and untreated

Diabetic Retinopathy

A number of authors have attempted to correlate cigarette smoking with the development and deterioration of diabetic retinopathy. This issue is of relevance both for individual patients and for public health, as the proportion of smokers among patients with diabetes is no smaller than that in the general population.38 Because of the well-known ischemic effect of smoking, it is reasonable to suggest that smoking affects the manifestations of diabetes in the retina as it does in other organs. In

Miscellaneous

Several studies have investigated the role of cigarette smoking in various other ocular disorders.

Summary

In summary, tobacco smoking, the leading preventable cause of morbidity and mortality in general, is also closely associated with severe ocular disorders. Most of the 4,000 active ingredients of tobacco smoke are potentially harmful to health. The list of ophthalmologic abnormalities linked to this dangerous habit is long and continues to grow. Both cataract and AMD, the most important causes of severe visual loss and blindness, are significantly related to cigarette smoking. Other pathologic

Method of Literature Search

Literature selection for this review was based on a MEDLINE search covering the past 25 years for all articles using the key words “smoking,” “cigarette,” “ocular,” and “ophthalmology.” The references contained in those articles were also reviewed and were selected if they provided further information on the subject.

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