Smoking, High Body Mass Index Associated With Dry Eye Disease Risk

Extreme Close-Up Of Eyes And Smoke
Clinicians should discuss smoking cessation and the benefits of diet and exercise with patients to maximize ocular surface functioning.

Individuals who smoke and those who have a high body mass index (BMI) tend to have greater risk of developing dry eye disease, according to a study published in Optometry and Vision Science. 

Researchers conducted a study of 90 participants (100% men) who were stratified into 3 groups: participants who smoke, those with a BMI higher than >25 kg/m2, and healthy controls (n=30 for all). They measured ocular surface parameters including noninvasive tear breakup time (NIBUT) and tear meniscus height (TMH), performed lipid layer pattern (LLP) assessment, and administered the Ocular Surface Disease Index (OSDI) to all participants.

The control group had lower median OSDI scores than those in the high BMI group (8.3 vs 10.2) and a higher median NIBUT than those in the smoking group (11.8 s vs 11.6 seconds), but these values did not achieve statistical significance. However, median TMH was significantly different between the smoking and control groups and between the high BMI and control groups (P =.03 and P =.04, respectively). Lipid layer pattern scores were also significantly higher in the control group compared with individuals in the high BMI and smoking groups (4.0, 2.0, and 2.4, respectively, P <.001).  

Researchers highlight the detrimental effects of smoking and high BMI on ocular health and state that “smoking leads to tear film instability, excessive tearing, reflex tears, and poor tear quality.” They also assert that BMI should be “checked on a regular basis to avoid health complications and risks of chronic illnesses, including dry eye.”

Study limitations include the strict inclusion of young men, small sample size, and single center design. 


Fagehi R, El-Hiti GA, Almojalli A, et al. Assessment of tear film parameters in smokers and subjects with a high body mass index. Optom Vis Sci. 2022;99(4):358-362. doi:10.1097/OPX.0000000000001891