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Apparent protective associations between smoking, alcohol consumption, and dry eye disease: evidence from a
Yan-Lin Wei1, Kai Cao1, Qing Zhang1
1Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology ＆ Visual Sciences Key Laboratory, Beijing, 100730, China.
Background:
To investigate the associations of current smoking and current alcohol consumption with dry eye disease (DED) in a community-based population of middle-aged and older adults, and to determine whether these associations persisted after accounting for demographic, lifestyle, environmental, and psychological factors.
Methods:
This cross-sectional analysis was conducted within the Beijing Adult Dry Eye Cohort (ADEC) and included 813 participants aged 45 years and older with complete baseline clinical and questionnaire data. DED was defined as an Ocular Surface Disease Index (OSDI) score of 13 or higher together with a non-invasive tear break-up time (NIBUT) of less than 10 s. NIBUT, tear meniscus height, tear meniscus area, and meibomian gland loss were evaluated as objective ocular-surface parameters. Demographic characteristics, lifestyle factors, and environmental exposures were collected using structured questionnaires, while anxiety and depression were assessed using validated scales. Associations of current smoking and current alcohol consumption with DED were examined using logistic regression models before and after multivariable adjustment.
Results:
Among 813 participants, 344 were classified as having DED, corresponding to a prevalence of 42.3%. In the unadjusted analysis, current smoking was associated with lower odds of DED; however, this association was no longer significant after adjustment for demographic, environmental, lifestyle-related, and psychological factors. Current alcohol consumption was not independently associated with DED. Differences in objective ocular-surface parameters were observed across smoking and alcohol-consumption groups. Participants who smoked or consumed alcohol showed longer NIBUT, but also greater meibomian gland loss, indicating that functional and structural ocular-surface parameters did not vary in a consistent direction.
Conclusions:
Current smoking and alcohol consumption should not be interpreted as protective against DED in clinical or public health contexts. Isolated favorable tear-film findings should be evaluated together with meibomian gland status and other ocular-surface features. These findings support comprehensive DED risk assessment and reinforce the importance of smoking cessation and avoidance of excessive alcohol consumption in public health messaging.
