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

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.