ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Impact of Smoking Exposure on Meibomian Gland Morphology and Tear Film Stability: A Cross-Sectional Study
Provisionally accepted
- 1Department of Ophthalmology, Shan xi cardiovascular hospital, Taiyuan, China
- 2Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan, China
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Purpose: To investigate the effects of smoking on the structure and function of the meibomian glands. Methods: A total of 104 chronic smokers (with a smoking history of more than 5 years) and 44 healthy non-smokers were included. Based on smoking index, participants were categorized into four groups: non-smoking, mild, moderate, and heavy smoking. Meibomian gland images were compared across groups to assess morphological features, including defect area, number, height, and width. Furthermore, eyelid margin morphology, meibum characteristics and quantity, as well as tear film breakup time (TBUT), were evaluated to further investigate the impact of smoking on the structure and function of the meibomian glands. Results: The gland dropout area demonstrated the strongest positive correlation with smoking index (β = 0.449, p < 0.001). The number, height, and width of meibomian glands were negatively correlated with smoking index (β = -0.258, p = 0.002;β = -0.192, p = 0.021; β = -1.176, p = 0.036, respectively). Furthermore, the eyelid margin morphology score and meibum secretion function worsened with increasing smoking index (B = 0.002, OR = 0.998, 95% CI: -0.001 to 0.003, p < 0.001, B = -0.002, OR = 0.998, 95% CI: -0.001 to -0.002, p < 0.001). Tear film stability showed negative correlations with smoking index (β = -0.245, p = 0.003). Conclusion: Increased smoking exposure is strongly associated with deleterious structural and functional alterations of meibomian glands. Increased smoking exposure is associated with more severe meibomian gland morphological damage, worsened eyelid margin signs, reduced meibum quality and quantity, and accelerated deterioration of tear film stability. The underlying mechanisms may involve oxidative stress and chronic inflammation induced by tobacco smoke. For the management of smoking-related meibomian gland dysfunction (MGD), smoking cessation should be advised along with targeted anti-inflammatory or antioxidant treatments.
Keywords: Meibomian gland1, Meibomian gland dysfunction, Meibomian gland morphology2, Meibum3, Tear Film Break-Up Time4, Smoking Index5, Oxidative stress6, inflammation7
Received: 23 Sep 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Chen, Wang, Liang and Feng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ting Chen, 15834124416@163.com
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