Key Takeaways
Smoking damages sensitive eye tissues and increases the risk of conditions like age-related macular degeneration and glaucoma.Secondhand smoke and cigarette residue can irritate the eyes.E-cigarettes may also affect eye health, though research is still limited on their long-term impact.
Smoking can damage several tissues and organ systems in the body, and the eyes are no exception.
Toxic chemicals in cigarette smoke enter the bloodstream and damage sensitive tissues in the retina, lens, and macula of the eye. That increases the risk of developing conditions like macular degeneration and glaucoma, which cause irreversible vision loss.
The Link Between Smoking and Eye Damage
Smoking tobacco introduces various toxic compounds into the body that trigger inflammation in the eyes and across the body. Nicotine also raises blood pressure and heart rate, which can restrict the tiny blood vessels in the eye. This can lead to fluid buildup in the retina, damage to the optic nerve, and an increased risk of glaucoma and age-related macular degeneration (AMD).
Even after people quit smoking, the base membrane of the retina remains damaged, and the very fine blood vessels there stay constricted, said Gregg Feinerman, MD, a board-certified eye surgeon and owner of Feinerman Vision.
This can enable waste products to build up under the retina, which can cause dry AMD to progress to the more severe wet AMD. Current smokers also tend to be less responsive to AMD treatments.
Genetics plays a role in up to 70% of AMD cases, and smoking can further raise the risk of macular degeneration in people with certain genetic traits. According to the Macular Society, a third of all AMD cases involve a combination of genetics and smoking.
“You can’t control your genetics, so you have to think about the things you can control,” said Taariq Mohammed, MD, assistant professor and vitreoretinal surgeon at the University of Maryland. “How much smoking increases the risk may vary a little bit by person. But regardless of your genetic profile at baseline, it makes sense to decrease or stop smoking as much as possible.”
Handling cigarettes can also cause surface-level damage to the eyes. Tar and nicotine on your hands can contaminate contact lenses, which can cause a burning sensation and dryness in the eyes, said Jacquie Bowen, OD, president of the American Optometric Association.
Constant irritation on the surface of the eye can increase the risk of developing cataracts, as well as dry eye and uveitis, or redness and inflammation of the iris.
Secondhand Smoke Can Also Damage the Eye
In addition to the systemic damage of smoking, handling cigarettes and being surrounded by smoke can cause eye irritation.
“The tar and nicotine can contaminate your contacts when you handle your lenses and give your eyes a burning sensation and contribute to dry eyes,” said Bowen.
A study from Hong Kong shows that young children who are exposed to secondhand smoke exhibit signs of damage to a part of the eye that supplies the retina with blood. Secondhand exposure to just one cigarette a day showed an effect.
People who smoke during pregnancy can also transmit toxins to the placenta, which increases the risk of fetal and infant eye disorders. Those include crossed eyes and underdevelopment of the optic nerve, which is a leading cause of blindness in children, Bowen said. Smoking during pregnancy can also cause premature birth, which raises the risk for vision problems in babies.
“The retina isn’t very good at regenerating itself once damaged, so any period of smoking during a person’s lifetime will contribute to the risk of developing AMD,” Bowen said. “Those people need to be especially consistent in having an eye exam.”
What About Vaping and Smoking Weed?
Electronic cigarettes and vaporizers work by heating and vaporizing a liquid that contains nicotine and flavoring. Bowen said the nicotine in those products can raise blood pressure and heart rate, which is harmful to eye health. A 2017 study found that some of the chemicals in e-cigarettes can exacerbate oxidative stress and inflammation, both of which can damage eye tissues.
A more recent study found that people who used e-cigarettes were likely to have moderate to severe dry eye and poorer tear film quality compared to healthy nonsmokers. E-cigarette use may also produce formaldehyde, a known eye irritant and possible carcinogen.
Mohammed said the link between cigarette smoking and eye diseases like AMD is “very well studied,” but e-cigarettes are newer products, and few human studies have examined their long-term impact on the eyes.
“Certainly, some of the compounds in e-cigarettes and vapes have been shown in cell models to have negative effects on the retina and layers around the retina. It would certainly be possible that that could have negative effects on the eye, but we just don’t know how severe it is at this point,” Mohammed said.
There is a bit more research on the effects of smoking cannabis, but the results aren’t conclusive. In some studies, people who smoked cannabis had lower eye pressure, which could help offset the effects of glaucoma. However, there’s other research showing that cannabis can release inflammatory compounds similar to those in cigarette smoke.
He said that while we await definitive studies, Mohammed recommends avoiding e-cigarettes and vapes.
Can You Do Anything to Offset the Effects of Smoking?
The best first step is to quit smoking altogether.
“Quitting smoking at any age, even later in life, can significantly reduce your risk of developing the condition,” Bowen said.
The Centers for Disease Control (CDC) recommends getting regular eye exams if you used to smoke or still do.
AMD often comes on without clear warning signs, so having an optometrist check your eyes yearly can help you catch the condition early on. To support your eye health as you age, Mohammed recommends eating a varied diet with antioxidant-rich vegetables and fruits, which can help moderate some of the inflammation triggered by tobacco smoking.
Certain healthy habits can also reduce your risk of developing AMD overall. Those include:
Exercising regularlyMaintaining normal blood pressure and cholesterol levelsEating a healthy diet rich in green leafy vegetables, antioxidants, and fishGetting annual comprehensive eye exams