Ophthalmology Times: The Harm of Vaping Aerosol to the Eyes

On February 15, foreign ophthalmology news magazine "Ophthalmology Times" cited research by Dr. Periman, an expert in ocular surface diseases, reporting that due to the many chemicals contained in e-cigarette liquids and the possibility that these components may not be regulated, the aerosol produced by e-cigarettes may have various effects on the eyes.

Here is the full text:

High nicotine levels are common

Unlike the nicotine content naturally present in tobacco in cigarettes, the nicotine content extracted from e-liquid is uncontrolled and often unknown.

Doctors are seeing diseases caused by nicotine ("nicotine sickness"), especially among adolescents. This includes seizures, anxiety disorders, depression, cognitive impairment, and attention deficits.

The effects of nicotine on the eyes include pupil constriction and a decrease in retinal activity visible on the electroretinogram (ERG).

E-liquids are filled with other chemicals

In addition to nicotine, vapor liquid components also include acrolein (2-propenal), an aldehyde that severely limits regulatory T cells, a mechanism that can activate and lead to chronic dry eye disease (DED).

Carriers and flavoring additives can also cause pulmonary toxicity and directly activate the transport receptor potential (TRP) of the ocular surface immune system and corneal nerves.

Some chemicals in vapor may also activate the immune mechanisms of chronic DED. Other potential components have other health impacts, including nitrosamines, benzaldehyde, benzyl alcohol, propylene glycol, and ethylene glycol.

Ingredients are basically unregulated

After changes in manufacturing, if a drug user develops severe pulmonary toxicity and requires a lung transplant, vitamin E was added to certain drug cartridges.

A review of the components of vapor liquids shows that 100% of the cartridges used by affected patients contained vitamin E, which had never appeared in the same cartridge brand before. Viscous esters are used as fillers but are unsafe to inhale.

Without regulations, it is impossible to know whether or when other potentially hazardous substances will be added to e-liquid in the future. The reputation of the brand does not guarantee the safety of our patients' lungs or other organ systems.

Researchers are now studying OSD and e-cigarettes

A recent paper compared ocular surface findings between e-cigarette users and non-users, finding that e-cigarette users had staining and disrupted tear break-up time.

The Schirmer test results in the e-cigarette user group were inconsistent, possibly due to the compensatory period of the lacrimal glands in dry eye disease, which gradually disappears over time. 

What should we do?

After reading more information about the chemicals involved in vaping and their effects, I am more convinced than ever that the treatment of ocular surface diseases (OSD) includes educating patients about natural and self-induced environmental challenges.

In particular, if they are exposed to chemicals that may affect the inflammatory cycle, treatments that can alleviate inflammation should be used, such as omega-3 fatty acids (HydroEye, ScienceBased Health), cyclosporine (Restasis, Allergan, Cequa, Sun), lifitegrast (Xiidra, Novartis), intense pulsed light therapy (Optima IPL, Lumenis), and thermal office modalities (TearCare, Sight Sciences; iLux, Alcon; and LipiFlow, Johnson & Johnson Vision) — can help tilt things in the right direction.

Most importantly, I have added vaping to the intake form for "dry eye services" in my practice. I want to know if patients use e-cigarettes and whether they are frequently exposed to secondhand vapor.

My patients need to understand the risks they are taking for their eyes and overall health. Efforts by doctors to educate patients often improve patient health.