Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 13;86(5):e20230069.
doi: 10.5935/0004-2749.20230069. eCollection 2023.

Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers

Mustafa Kalayci  1 , Ersan Cetinkaya  1 , Lütfiye Yaprak  1 , Kenan Yigit  1 , Elcin Suren  1 , Berna Dogan  1 , Muhammet Kazim Erol  1
Affiliations

Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers

Mustafa Kalayci et al. Arq Bras Oftalmol. .

Abstract
in English, Portuguese

Purpose: The study aimed to evaluate the ocular surface and meibomian gland morphology in electronic cigarette (e-cigarette) smokers.

Methods: The upper and lower eyelids of 25 male e-cigarette smokers and 25 healthy male non-smoker patients were evaluated using Sirius meibography. Meibomian glands loss was automatically calculated using Phoenix meibography imaging software module, with the result obtained as percentage loss. Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time test, and Schirmer II test were administered and performed in all cases.

Results: The mean e-cigarette smoking duration was 4.9 ± 0.9 (range, 3.4-7) years. While the mean Schirmer II test value was 9.16 ± 2.09 mm in e-cigarette group, it was 11.20 ± 2.14 mm in control group (p=0.003). Mean tear breakup time was 6.96 ± 2.31 seconds in e-cigarette group and 9.84 ± 2.13 seconds in control group (p=0.002). The mean OSDI value was 28.60 ± 6.54 and 15.16 ± 7.23 in e-cigarette and control groups, respectively (p<0.001). In Sirius meibography, the average loss for the upper eyelid was 23.08% ± 6.55% in e-cigarette group and 17.60% ± 4.94% in control group (p=0.002), and the average loss for the lower eyelid was 27.84% ± 5.98% and 18.44% ± 5.91%, respectively (p<0.001). Additionally, a significant positive correlation was identified between the loss rates for both upper and lower eyelid meibography with e-cigarette smoking duration (r=0.348, p<0.013 and r=0.550, p<0.001, respectively).

Conclusion: Long-term e-cigarette smoking causes damage to the meibomian glands; therefore, meibomian gland damage should be considered in ocular surface disorders due to e-ci-garette smoking.

Objetivo: Avaliar a superfície ocular e a morfologia da glândula meibomiana em usuários de cigarros eletrônicos.

Métodos: Foram avaliadas através de meibografia Sirius as pálpebras superiores e inferiores de 25 usuários de cigarros eletrônicos do sexo masculino e 25 pacientes não usuários saudáveis, também do sexo masculino. A perda nas glândulas meibomianas foi calculada automaticamente com o módulo de software de imagem de meibografia Phoenix. O resultado foi obtido como perda percentual. O questionário Ocular Surface Disease Index (OSDI), o teste do tempo de ruptura lacrimal e o teste de Schirmer II foram administrados em todos os casos.

Resultados: A duração média do uso de cigarros eletrônicos foi de 4,9 ± 0,9 anos (intervalo de 3,4-7 anos). O valor médio do teste de Schirmer II foi de 9,16 ± 2,09 mm no grupo de usuários de cigarros eletrônicos e de 11,20 ± 2,14 mm no grupo controle (p=0,003). O valor médio do teste do tempo de ruptura lacrimal foi de 6,96 ± 2,31 segundos no grupo de usuários de cigarros eletrônicos e 9,84 ± 2,13 segundos no grupo controle (p=0,002). O valor médio do Ocular Surface Disease Index foi de 28,60 ± 6,54 e 15,16 ± 7,23 para os grupos de usuários de cigarros eletrônicos e controle, respectivamente (p<0,001). Na meibografia de Sirius, a perda média para a pálpebra superior foi de 23,08 ± 6,55% para o grupo de usuários de cigarros eletrônicos e 17,60 ± 4,94% para o grupo controle (p=0,002), e a perda média para a pálpebra inferior foi de 27,84 ± 5,98% e 18,44 ± 5,91%, respectivamente (p<0,001). Além disso, foi observada uma correlação positiva significativa entre a taxa de perda na meibografia palpebral superior e inferior com a duração do tabagismo eletrônico, respectivamente de (r=0,348, p<0,013) e (r=0,550, p<0,001).

Conclusão: O uso prolongado de cigarros eletrônicos causa danos às glândulas meibomianas. Portanto, esses danos devem ser considerados em distúrbios da superfície ocular devidos ao uso desses dispositivos.

PubMed Disclaimer

Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The eyelids borders were marked using the Phoenix software module.
Figure 2
Figure 2
The meibomian glands were marked using the Phoenix software module.
Figure 3
Figure 3
The loss in the meibomian glands was automatically calculated using the Phoenix software module.
Figure 4
Figure 4
The meibomian gland loss rate of a patient’s upper eyelid from study group.
See this image and copyright information in PMC

References

    1. Etter JF, Eissenberg T. Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes. [cited 2020 Nov 21];Drug Alcohol Depend [Internet] 2015 147:68–75. Available from: Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes (nih.gov) - PMC - PubMed
    1. Papaefstathiou E, Stylianou M, Agapiou A. Main and side stream effects of electronic cigarettes. J Environ Manage. 2019;238:10–17. - PubMed
    1. Hess CA, Olmedo P, Navas-Acien A, Goessler W, Cohen JE, Rule AM. E-cigarettes as a source of toxic and potentially carcinogenic metals. [cited 2020 Oct 15];Environ Res [Internet] 2017 152:221–225. Available from: E-CIGARETTES AS A SOURCE OF TOXIC AND POTENTIALLY CARCINOGENIC METALS (nih.gov) - PMC - PubMed
    1. Mohamed Mostafa E, Abdellah MM, Elhawary AM, Mounir A. Noncontact meibography in patients with keratoconus. [cited 2020 Mar 19];J Ophthalmol [Internet] 2019 2019:1–6. Available from: Noncontact Meibography in Patients with Keratoconus (nih.gov) - PMC - PubMed
    1. Arita R, Fukuoka S, Morishige N. Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction. [cited 2020 Apr 5];Ocul Surf [Internet] 2019 17(1):104–110. Available from: Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction - ScienceDirect. - PubMed