The Effect of Smoking on the Ocular Surface, Tear Film, and Central Corneal Thickness


  • Amal Saeed Alghamdi Prince Meshari Bin Saud- General Baljurashi Hospital, Saudi Arabia
  • Ferial Zeried Collage of Applied Medical Science, Saudi Arabia


Cigarette smoking, Ocular surface, Dry eye, Central Corneal Thickness, Speed Dry Eye


Background: As a global health issue, smoking is a growing concern for Saudi Arabia and the world. It is known that exposure to harmful chemicals in cigarettes can affect the anterior ocular surface. Main purpose: The objective of this study is to investigate the effects of smoking on the central corneal thickness and the ocular surface parameters at smokers. It also compares the results with those of non-smokers and passive smokers.  Materials and Methods: A cross?sectional study was adopted and comprised 118 participants: 50 smokers, and 68 non-smokers. The goal of the Speed II Questionnaire was to assess the severity of ocular surface disease symptoms. Participants were tested using various methods, such as the Schirmer's II test, tear Meniscus height (TMH), the Non-Invasive Break-Up Time (NIK-BUT), and Central corneal thickness (CCT).  Results:  The difference in Schirmer's scores and those of the other parameters were statistically significant. The mean values of all dry eye parameters were also different between the groups of smokers and non-smokers. The mean Corvis ST was less for both right and left eyes, but this difference was not significant. The dry eye symptoms (Dryness, Grittiness or Scratchiness, Soreness or Irritation, Burning or Watering, and Eye Fatigue) showed a statistically significant association among groups (p <0.01). Conclusion: Cigarette smoking causes dry eye parameters like Schirmer test score, TMH, and TBUT to deteriorate. Also, we found a strong correlation among groups and dry eye symptoms in terms of frequency and severity. The smoker group had the most suffering of dry eye symptoms in terms of frequency and severity. However, CCT was discovered to be unrelated to smoking. More researches are needed to identify the molecular basis of the relationship between smoking intensity and its effect on the tear film and corneal thickness in terms of free radicals.


. Mackenbach, J. P., Damhuis, R. A., & Been, J. V. (2017). De gezondheidseffecten van roken [The effects of smoking on health: growth of knowledge reveals even grimmer picture]. Nederlands tijdschrift voor geneeskunde, 160, D869.

. Onor, I. O., Stirling, D. L., Williams, S. R., Bediako, D., Borghol, A., Harris, M. B., Darensburg, T. B., Clay, S. D., Okpechi, S. C., & Sarpong, D. F. (2017). Clinical Effects of Cigarette Smoking: Epidemiologic Impact and Review of Pharmacotherapy Options. International journal of environmental research and public health, 14(10), 1147.

. Alshamrani, A. A., Almousa, A. S., Almulhim, A. A., Alafaleq, A. A., Alosaimi, M. B., Alqahtani, A. M., Almulhem, A. M., Alshamrani, M. A., Alhallafi, A. H., Alqahtani, I. Z., & Alshehri, A. A. (2017). Prevalence and Risk Factors of Dry Eye Symptoms in a Saudi Arabian Population. Middle East African journal of ophthalmology, 24(2), 67–73.

. Saha, S. P., Bhalla, D. K., Whayne, T. F., Jr, & Gairola, C. (2007). Cigarette smoke and adverse health effects: An overview of research trends and future needs. The International journal of angiology : official publication of the International College of Angiology, Inc, 16(3), 77–83.

. Mohidin, N., & Jaafar, A. B. (2020). Effect of Smoking on Tear Stability and Corneal Surface. Journal of current ophthalmology, 32(3), 232–237.

. Mitchell, P., Liew, G., Gopinath, B., & Wong, T. Y. (2018). Age-related macular degeneration. Lancet (London, England), 392(10153), 1147–1159.

. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). The ocular surface, 5(2), 75–92.

. Alsahly, R. J., Aldawsari, A. A., Alzaidy, N. F., Al Jabr, F. A., Alotaibi, M. M., & Mohammed, E. Y. (2022). Dry Eye Disease Symptoms and Its Association with Daily Beverage Intake Among Adults in Saudi Arabia. Clinical ophthalmology (Auckland, N.Z.), 16, 453–460.

. Alharbi AJ, Alanazi NA, Alhamad JR, et al. Prevalence of symptomatic dry eye and its risk factors among coastal population in Eastern Province of Saudi Arabia. EC Ophthalmol. 2019;10(6):503–509.

. Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., Joo, C. K., Liu, Z., Nelson, J. D., Nichols, J. J., Tsubota, K., & Stapleton, F. (2017). TFOS DEWS II Definition and Classification Report. The ocular surface, 15(3), 276–283.

. Bukhari, A., Ajlan, R., & Alsaggaf, H. (2009). Prevalence of dry eye in the normal population in Jeddah, Saudi Arabia. Orbit (Amsterdam, Netherlands), 28(6), 392–397.

. World Health Organization. (2019). WHO report on the global tobacco epidemic, 2019: Offer help to quit tobacco use. World Health Organization.?

. Anti-smoking campaign launched. (2017, May 30).

. Almutairi, A. H., Alalawi, B. S., Badr, G. H., Alawaz, R. A., Albarry, M., & Elbadawy, H. M. (2021). Prevalence of dry eye syndrome in association with the use of contact lenses in Saudi Arabia. BMC ophthalmology, 21(1), 147.

. Fletcher,J.(February 23,2017).schimer's test: what happens in the dry eye test?. Medically reviewed by Euna chi,M.D.

. Jiang.X, Song,H.(2016).tear break-up time (TBUT)and tear meniscus height (TMH).

. 2016.? Tian, L., Qu, J. H., & Sun, X. G. (2016). Repeatability and reproducibility of noninvasive keratograph 5M measurements in patients with dry eye disease. Journal of ophthalmology.

. Yang,K. liyan xu.(2019).repeatability and comparison of new corvis ST parameters in normal and keratoconus eyes.

. Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., Joo, C. K., ... & Stapleton, F. (2017). TFOS DEWS II definition and classification report. The ocular surface, 15(3)

. Vehof, J., Kozareva, D., Hysi, P. G., & Hammond, C. J. (2014). Prevalence and risk factors of dry eye disease in a British female cohort. British Journal of Ophthalmology, 98(12)

. Chia, E. M., Mitchell, P., Rochtchina, E., Lee, A. J., Maroun, R., & Wang, J. J. (2003). Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clinical & experimental ophthalmology

. Satici, A., Bitiren, M., Ozardali, I., Vural, H., Kilic, A., & Guzey, M. (2003). The effects of chronic smoking on the ocular surface and tear characteristics: a clinical, histological and biochemical study. Acta Ophthalmologica Scandinavica, 81(6)

. Bhutia, P., Sen, S., Nath, T., & Shamshad, M. A. (2021). The effect of smoking on ocular surface and tear film based on clinical examination and optical coherence tomography. Indian journal of ophthalmology.

. N. B. T. effect of smoking on the ocular surface and the precorneal tear film. A. M. J. 2012;5(4):221-6. doi: 10. 4066/AMJ. 2012. 1035. E. 2012 A. 30. P. 22848314; P. P. Thomas J, Jacob GP, Abraham L.

. Xu, L., Zhang, W., Zhu, X. Y., Suo, T., Fan, X. Q., & Fu, Y. (2016). Smoking and the risk of dry eye: a Meta-analysis. International journal of ophthalmology, 9(10).

. Mohidin, N., & Jaafar, A. B. (2020). Effect of smoking on tear stability and corneal surface. Journal of Current Ophthalmology, 32(3).

. Thomas, J., Jacob, G. P., Abraham, L., & Noushad, B. (2012). The effect of smoking on the ocular surface and the precorneal tear film. The Australasian Medical Journal, 5(4)

. Hara, K. (1991). Effects of cigarette smoking on ocular circulation chronic effect on choroidal circulation. Nippon Ganka Gakkai Zasshi, 95(10)

. Altinors, D. D., Akça, S., Akova, Y. A., Bilezikçi, B., Goto, E., Dogru, M., & Tsubota, K. (2006). Smoking associated with damage to the lipid layer of the ocular surface. American journal of ophthalmology, 141(6).

. Kirkham, P. A., Spooner, G., Rahman, I., & Rossi, A. G. (2004). Macrophage phagocytosis of apoptotic neutrophils is compromised by matrix proteins modified by cigarette smoke and lipid peroxidation products. Biochemical and biophysical research communicat.

. Calonge, M., Enríquez-de-Salamanca, A., Diebold, Y., González-García, M. J., Reinoso, R., Herreras, J. M., & Corell, A. (2010). Dry eye disease as an inflammatory disorder. Ocular immunology and inflammation, 18(4)

. Arnson, J., Shoenfeld, Y., & Amital, H. (2010). Effects of tobacco smoke on immunity, inflammation and autoimmunity. Journal of autoimmunity, 34(3)

. Timothy, C. O., & Nneli, R. O. (2007). The effects of cigarette smoking on intraocular pressure and arterial blood pressure of normotensive young Nigerian male adults. Nigerian journal of physiological sciences.

. Williamson, T. H., Lowe, G. D., & Baxter, G. M. (1995). Influence of age, systemic blood pressure, smoking, and blood viscosity on orbital blood velocities. British Journal of Ophthalmology, 79(1)

. Lee, A. J., Lee, J., Saw, S. M., Gazzard, G., Koh, D., Widjaja, D., & Tan, D. T. H. (2002). Prevalence and risk factors associated with dry eye symptoms: a population based study in Indonesia. British Journal of Ophthalmology, 86(12)

. Tank, P., & Kulkarni, U. (2019). C. of dry eyes tests among S. and N. D. smoking predispose to dry eye. ..

. Cometto-Muñiz, J. E., & Cain, W. S. (1992). Part iii. Assessing irritation: Sensory irritation: Relation to indoor air pollution. Annals of the New York Academy of Sciences, 641(1 Sources of In)

. Sayin, N., Kara, N., Pekel, G., & Altinkaynak, H. (2014). Effects of chronic smoking on central corneal thickness, endothelial cell, and dry eye parameters. Cutaneous and ocular toxicology

. Golabchi, K., Abtahi, M. A., Salehi, A., Jahanbani-Ardakani, H., Ghaffari, S., & Farajzadegan, Z. (2018). The effects of smoking on corneal endothelial cells: a cross-sectional study on a population from Isfahan, Iran. Cutaneous and ocular toxicology, 37(1), 9-14.?

. Silva, R. N., Taniguchi, E. V., Cruzat, A., Paschalis, E. I., Pasquale, L. R., Colby, K. A., ... & Shen, L. Q. (2020). Angle anatomy and glaucoma in patients with Boston keratoprosthesis. Cornea




How to Cite

Amal Saeed Alghamdi, & Ferial Zeried. (2022). The Effect of Smoking on the Ocular Surface, Tear Film, and Central Corneal Thickness. International Journal of Natural Sciences: Current and Future Research Trends, 15(1), 1–14. Retrieved from