It’s no secret that smoking causes devastating health problems — including to your eyes. 

Some smokers think they’ve found a solution: electronic cigarettes, which produce none of the smoke of traditional cigarettes. 

Also known as vapes or e-cigs, these battery-powered devices heat a liquid concoction and turn it into steam, which is inhaled by the user. Invented in China in 2003, e-cigarettes’ global market is expected to reach $30 billion by 2027, according to a 2022 Researchandmarkets.com report. 

Many users continue to believe vaping is less damaging than traditional cigarettes—maybe not benign, but a kinder, gentler alternative for your whole body, including your eyes. Are they right? Let’s look at the research.

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What We Know About Vaping

Despite initial claims that the vapor from e-cigs was primarily made up of harmless water droplets, today’s devices often spew an aerosol cloud infused with nicotine, formaldehyde, artificial flavorings, and other worrisome ingredients. 

In a 2021 study in International Ophthalmology, researchers found that some of these e-cigarette additives could cause corneal straining and damage your eye's tear film and lipid layers. A quick look at these common ingredients shows some reason for concern.

Nicotine. It’s not only one of the most addictive substances on earth—considered as habit forming as cocaine—but it’s also a known eye irritant, even when it’s ingested rather than airborne. That's because nicotine affects blood flow to your eyes.

One study in the British Journal of Ophthalmology examined teens who chewed nicotine-laced gum and found that the practice can lead to thinning of the choroid, a vascular layer of the eye that provides oxygen to the retina. This is troubling to eye-care professionals. 

“One of the e-cigarette brands doubled the amount of nicotine in its vapors, and I’m afraid that can cause almost immediate dependency,” says Daniel Bintz, O.D., an Elk City, Oklahoma, optometrist who authored the American Optometric Association fact sheet on cigarette smoking and eye health.

Flavorings. There are countless enticing flavors available for e-cigarettes. Some of the most popular include diacetyl, the same chemical once known for imparting the buttery flavor to microwave popcorn.  

When diacetyl is made into vapor, it can be inhaled and cause “popcorn lung,” which can lead to irreversible damage and death. The American Lung Association says that while major popcorn manufacturers removed diacetyl from their products, “some people are still being exposed to diacetyl through e-cigarette vapor.”

IN a 2021 JAMA Pediatrics study, researchers concluded that a single 30-minute vaping session can significantly increase “oxidative stress,” which can damage eyes. Oxidative stress occurs when there is an imbalance between free radicals (molecules that can damage cells) and antioxidants, which fight those free radicals.

“I have to believe that repeated exposure to these vapors can cause the kind of oxidative damage that can worsen serious problems like macular degeneration and cataracts over time,” says Emily Chew, M.D., director of the Division of Epidemiology and Clinical Applications and the deputy clinical director at the National Eye Institute (NEI), National Institutes of Health (NIH). “Your eyes and your body can overcome only so much oxidative stress.”

Formaldehyde. A by-product of combustion in both conventional and electronic cigarettes, formaldehyde is a possible carcinogen and a proven eye irritant. The National Cancer Institute warns that airborne formaldehyde can cause burning sensations and watering of the eyes. 

E-cigarette vapor includes formaldehyde and its first cousins, acrolein and acetaldehyde. To the experts, it’s just another example of the risks from e-cigs. “All these things in vaping can cause problems for eyes and, in fact, the entire body,” says Dr. Bintz.

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What We Don’t Know About Vaping

The truth is, almost no current scientific research definitively links vaping to eye problems, and there’s a good reason for that. 

Sumayya Ahmad, M.D., assistant professor of ophthalmology at the Icahn School of Medicine at Mount Sinai, New York City, points out that e-cigarettes haven’t been around long enough to be subjected to extensive scholarly study. And what limited research has been done understandably focused on potential lung problems or nicotine addiction rather than eye health. 

Meanwhile, vaping continues its rapid rise in popularity, especially among the young. The Centers for Disease Control and Prevention estimates that more than 2 million middle school and high school students used e-cigarettes in 2021. The American Optometric Association describes the popularity of vaping among teens and young adults as nearing “epidemic proportions.”

“Young people tend to feel pretty invincible,” says Dr. Ahmad. “I suspect this generation will see the effects in later years.” 

In some rare cases, the damage comes much sooner. Teens and others who attempt to intensify the vaping experience by hacking electronic cigarettes can put themselves at deadly risk.

In one case, a vape user who attempted to modify the heating element of his device by substituting a home-made copper coil for the original one almost lost an eye when the contraption exploded near his face. A subsequent probe by Malaysian experts concluded that trying to alter electronic cigarettes can “potentially cause significant and permanent visual impairment.” 

The Case Against Vaping

In 2021, scientists at the University of California found that people who vape were 34% more likely to suffer from visual impairments compared to those who never tried vaping.

And a 2019 study from Optometry and Vision Science found that those who vaped were more likely to suffer from moderate to severe dry eye compared to nonsmokers.

“I just think that there’s no safe way to use a hot, high-pressure device near your eyes and face,” Dr. Bintz says. “There’s always more risk involved in doing it than not doing it.” 

Meanwhile, the potential for accidents has led the FAA to prohibit the devices in checked baggage and not allow them to be used or charged while in aircraft cabins.

States also now regulate where vaping can occur, and pregnant women and parents of young children have been advised to avoid e-cigarettes entirely, with the American Optometric Association contending that the vapor “can cause harm to the developing brains of children under 18 and could cause harm to a fetus.” 

“We know that when babies in utero are exposed to some of the toxic chemicals in smoke, they can develop eye problems that, if not treated in time, can lead to serious and permanent vision problems,” warns Dr. Chew. 

Given the aerosol brew produced by e-cigarettes, she expects the outcome is likely to be the same. “We know that prolonged exposure to regular cigarettes increases the risk for eye diseases,” she says, “but vaping doesn’t seem to be safe for eyes, either.”