Macular Degeneration 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] .

7.2.8 Retinal Detachment

The฀question฀of฀an฀association฀with฀smoking฀was฀pursued฀in฀a฀study฀in฀198฀patients฀with฀reti- nal฀detachment.฀It฀was฀found฀that฀the฀relative฀risk฀for฀retinal฀detachment฀was฀increased฀age- dependently฀by฀the฀presence฀of฀myopia,฀but฀was฀decreased฀by฀current฀smoking฀RR฀=฀0.5;฀ 95฀CI:฀0.3–0.8฀ [188] .

7.3 Ears, Oral Cavity and Larynx

7.3.1 Harmful Effects on the Ears

The฀literature฀contains฀only฀a฀small฀number฀of฀publications฀on฀the฀effects฀of฀smoking฀on฀ hearing,฀although฀it฀can฀probably฀be฀assumed฀that฀blood฀low฀in฀the฀middle฀and฀inner฀ear฀is฀ comparable฀with฀that฀in฀the฀CNS฀and฀that฀hypoxaemic฀states฀together฀with฀microcirculatory฀ changes฀raised฀ibrinogen,฀etc.฀are฀causally฀linked฀with฀the฀harmful฀effects฀of฀smoking฀ [189] .฀According฀to฀a฀study฀in฀163฀patients฀with฀sudden฀deafness,฀smokers฀also฀had฀signii- cantly฀more฀risk฀factors฀for฀coronary฀heart฀disease฀compared฀with฀a฀healthy฀control฀group฀ [190] .฀ Similarly,฀ in฀ 2,348฀ patients฀ with฀ noise-induced฀ hearing฀ loss,฀ the฀ relative฀ risks฀ for฀ smokers฀were฀signiicantly฀elevated฀ever-smoker:฀OR฀=฀1.27,฀p฀=฀0.02;฀current฀smoker:฀ OR฀=฀1.39,฀p฀=฀0.002฀compared฀with฀never-smokers,฀and฀associations฀were฀even฀detected฀ with฀the฀number฀of฀pack-years฀of฀smoking฀ [191] .฀In฀a฀further฀experimental฀series,฀the฀hearing฀ of฀smokers฀and฀non-smokers฀was฀compared,฀following฀adjustment฀for฀other฀factors:฀current฀ smokers฀were฀1.69฀times฀as฀likely฀to฀have฀hearing฀loss฀as฀non-smokers฀ [192] .฀Compared฀with฀ non-exposed฀persons,฀passive฀smokers฀who฀lived฀with฀a฀smoker฀were฀also฀found฀to฀be฀at฀ increased฀risk฀for฀hearing฀loss฀OR฀=฀1.94;฀CI:฀1.01–3.74฀ [192] .฀It฀has฀not฀yet฀been฀fully฀ established฀whether฀auditory฀damage฀occurs฀primarily฀in฀the฀high-frequency฀range฀ [193] .

7.3.2 Changes in the Oral Cavity

All฀tobacco฀consumption฀i.e.฀including฀chewing฀tobacco฀and฀especially฀cigarette฀smoking฀ produces฀changes฀in฀the฀oral฀cavity,฀for฀example,฀mucosal฀changes฀in฀the฀form฀of฀gingivitis฀ [194],฀[195] ฀and฀increased฀tooth฀loss฀ [194,฀196–198] .฀Periodontal฀diseases฀are฀disproportion- ately฀prevalent฀in฀smokers฀ [199–202] .฀In฀the฀USA,฀80฀of฀all฀adult฀cases฀of฀periodontal฀dis- ease฀can฀be฀associated฀with฀smoking฀ [203] .฀Acute฀ulcerative฀gingivitis฀as฀a฀consequence฀of฀ smoking฀has฀been฀known฀for฀more฀than฀50฀years฀ [194] :฀irstly,฀local฀lesions฀are฀produced฀on฀ the฀mucosal฀surface฀by฀the฀tar฀and฀other฀smoke฀products;฀and฀secondly,฀plaque฀formation฀with฀ bacterial฀colonisation฀is฀encouraged฀ [204] .฀Many฀of฀the฀processes฀involved฀have฀still฀to฀be฀ elucidated.฀However,฀it฀has฀been฀demonstrated฀that฀smokers฀have฀reduced฀salivary฀IgA฀and฀