Ingredients are largely unregulated.
The rash of cases where vapers experienced severe lung toxicity requiring lung transplants occurred after a change in manufacturing resulted in the addition of vitamin E to some vaping cartridges.7
A retrospective analysis of the vaping fluid composition showed that 100% of the cartridges used by the affected patients contained vitamin E, which had not been present in the same cartridge brand in the past. The sticky ester was used as a filler, but it is not safe for inhalation.
Without regulation, it is impossible to know if or when other potentially dangerous substances will be added to vaping fluid in the future. The reputation of the brand does not confer pulmonary or other organ system safety to our patients.
Researchers are now studying OSD and vaping.
One recent paper looked at ocular surface findings in vapers versus non-vapers and found that vapers had staining and compromised tear breakup time.8
Schirmer’s tests were inconsistent in the vaping group, and may be attributed to compensatory lacrimal gland output phases of dry eye disease, which can burn out over time.
What should we do?
After reading more about the chemicals involved in vaping and their effects, I believed more than ever that treatment for ocular surface disease (OSD) includes educating patients on natural and self-induced environmental challenges.
Particularly, if they are exposed to chemicals that may affect the inflammatory cycle, then treatments that reduce inflammation—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 in-office modalities (TearCare, Sight Sciences; iLux, Alcon; and LipiFlow, Johnson & Johnson Vision)—may be offered to help tip the scales in the positive direction.
Most importantly, I’ve added vaping to my practice’s Dry Eye Services intake form. I want to know if patients vape, as well as if they’re routinely exposed to vaping secondhand.
My patients need to understand the risks they’re taking for their eyes and their overall health. Physician efforts to educate patients often result in improved patient health.
About the author
Laura M. Periman, MD
E: [email protected]
Dr. Periman is an ocular surface disease expert and director of Dry Eye Services and Clinical Research in Seattle, Washington.