Graves’ Ophthalmopathy Ocular Diseases

Recently,฀smoking฀has฀also฀been฀reported฀to฀be฀associated฀with฀hereditary฀optic฀neuropa- thy,฀a฀rare฀disease฀with฀higher฀penetrance฀in฀men฀than฀in฀women฀ [181] .

7.2.5 Glaucoma

In฀a฀comparison฀of฀83฀patients฀with฀deinite฀glaucoma,฀121฀suspected฀cases฀and฀237฀healthy฀ controls,฀the฀risk฀for฀glaucoma฀was฀found฀to฀be฀increased฀in฀current฀smokers฀OR฀com- pared฀with฀non-smokers฀=฀2.9;฀CI:฀1.3–6.6.฀However,฀this฀increased฀risk฀was฀smaller฀than฀ that฀accounted฀for฀by฀untreated฀hypertension฀OR฀=฀5.8;฀CI:฀2.2–15฀ [182] .฀Suggestive฀ associations฀were฀also฀found฀with฀family฀history฀of฀glaucoma,฀deinite฀or฀borderline฀diabe- tes฀and฀myopia.฀The฀vascular฀effects฀of฀nicotine฀were฀studied฀in฀a฀comparison฀of฀11฀glau- coma฀patients฀and฀8฀controls:฀although฀low฀velocities฀were฀slightly฀reduced,฀no฀signiicant฀ differences฀were฀detected฀ [183] . Bonovas฀et฀al.฀performed฀a฀detailed฀meta-analysis฀of฀studies฀published฀in฀peer-reviewed฀ literature฀on฀the฀role฀of฀cigarette฀smoking฀as฀a฀risk฀factor฀for฀primary฀open-angle฀glau- coma฀POAG.฀They฀analysed฀seven฀studies฀and฀reported฀summary฀odds฀ratios฀from฀a฀ ixed-effects฀model฀which฀were฀1.37฀95฀CI:฀1.00–1.87฀for฀current฀smokers฀and฀1.03฀ 95฀CI:฀0.77–1.38฀for฀past฀smokers.฀The฀authors฀concluded฀that฀current฀smokers฀are฀at฀ signiicantly฀ increased฀ risk฀ of฀ developing฀ POAG.฀ Efforts฀ should฀ be฀ directed฀ towards฀ ฀augmenting฀the฀campaign฀against฀smoking฀by฀adding฀the฀increased฀risk฀of฀POAG฀to฀the฀ better-known฀arguments฀against฀smoking฀ [184] .

7.2.6 Strabismus

A฀multicentre฀case-control฀study฀was฀conducted฀in฀377฀children฀born฀to฀mothers฀who฀ smoked.฀Examination฀of฀these฀children฀revealed฀that฀cigarette฀smoking฀was฀associated฀ with฀an฀increased฀risk฀for฀esotropia฀OR฀compared฀with฀controls฀=฀1.8;฀95฀CI:฀1.1–2.8฀ but฀not฀for฀exotropia.฀The฀association฀of฀maternal฀smoking฀throughout฀pregnancy฀and฀ esotropia฀ was฀ strongest฀ for฀ children฀ who฀ weighed฀ less฀ than฀ 2,500฀ g฀ OR฀ =฀ 8.2;฀ CI:฀ 1.1–62.7฀or฀3,500฀g฀or฀more฀at฀birth฀OR฀=฀5.6;฀CI:฀2.1–15.4.฀The฀risk฀was฀increased฀ when฀the฀mother฀also฀smoked฀after฀pregnancy฀in฀the฀presence฀of฀the฀child฀ [185] .

7.2.7 Ocular Tumours

While฀it฀is฀uncertain฀whether฀any฀causal฀relationship฀exists฀at฀all,฀an฀association฀has฀been฀ reported฀between฀cigarette฀smoking฀and฀basal฀cell฀carcinoma฀of฀the฀eyelids฀in฀women฀but฀ not฀ in฀ men฀ OR฀ =฀ 2.87฀ vs.฀ 1.30;฀ not฀ statistically฀ signiicant฀ [186] .฀ The฀ question฀ as฀ to฀ whether฀uveal฀melanomas฀are฀encouraged฀by฀smoking฀remains฀to฀be฀clariied.฀However,฀no฀ differences฀were฀reported฀between฀non-smokers฀and฀smokers฀in฀terms฀of฀progression฀within฀ 3฀years฀following฀irradiation฀ [187] .