Editor’s Note: Welcome to “Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. “Let's Chat” continues with this latest piece by Laura Periman, MD. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or MJH Life Sciences.
The headlines are disturbing: Vaping has been linked to deaths, as well as lung transplants for otherwise healthy teens.
What’s going on? What are the implications for the eyes?
We know that exposure to any smoke can inflame the ocular surface, but what about vapor from vaping? Can vaping affect other parts of the eyes as well?
I found some unsettling answers.
Previously by Dr. Periman: Ophthalmology can 'adopt' technologies from other specialties
High nicotine levels are common.
Unlike cigarettes, which contain the amount of nicotine that naturally occurs in tobacco, vaping fluid contains extracted nicotine in levels that are uncontrolled and often unknown.
Doctors are seeing nicotine-induced illness (“nic-sick”), particularly in teens.1 This includes seizures, anxiety, depression, cognitive compromise, and inattention.
Pictured: A 36-year old ocular surface disease (OSD) meibomian gland dysfunction (MGD) patient who frequently uses vaped THC.
Photo credit: Laura M Periman MD
Effects of nicotine on the eye include pupil constriction2 and reduced retinal activity visible on electroretinogram (ERG).3
Vaping fluid is packed with other chemicals.
In addition to nicotine, vaping fluid components include acrolein (2-propenal), an aldehyde that severely limits regulatory t-cells — a mechanism that can thereby activate and contribute to chronic dry eye disease (DED).4
Carriers and flavor additives can also cause lung toxicity and directly activate the transit receptor potential (TRP) of the ocular surface immune system and corneal nerves.5
Some vaping chemicals may also activate the immune mechanism of chronic DED.6 Other potential components have additional health implications as well, including nitrosamines, benzaldehyde, benzyl alcohol, propylene glycol, and ethylene glycol.