Impact of tobacco use on corneal thickness and endothelial health: a systematic review with meta-analyses

Lith Elizabeth Wienholtz Frifelt, Yousif Subhi, Lars Morten Holm, Amardeep Singh

5 Citations (Scopus)


PURPOSE: To investigate the impact of tobacco use on corneal thickness and corneal endothelial health.

METHODS: We searched the PubMed/MEDLINE, EMBASE, the Cochrane Central and all affiliated databases of the Web of Science on 20 July 2020. Two authors reviewed the studies and extracted the data in an independent fashion. Studies were reviewed qualitatively in the text, and central corneal thickness (CCT) and corneal endothelial characteristics (endothelial cell density, endothelial cell variability, average of endothelial cell size and endothelial cell hexagonality) were introduced for quantitative analyses.

RESULTS: Eighteen studies (2077 were smokers and 6429 non-smokers) were identified, of which 17 studies provided data eligible for one or more of the quantitative analyses. When compared to non-smokers, smokers had a higher CCT (+3.3 μm, 95% CI: +0.9 to +5.7 μm, p = 0.007) and a lower endothelial cell density (-140 cells/mm2 , 95% CI: -30 to -250 cells/mm2 , p = 0.01). Other corneal endothelial measures did not differ significantly.

CONCLUSION: Tobacco use is associated with a higher CCT and lower corneal endothelium cell density, but the clinical impact of these findings is small. Further studies are warranted on patients with a priori poor corneal health, where smoking may constitute an important risk of further progression, for example upon anterior segment surgery.

Original languageEnglish
JournalActa Ophthalmologica
Issue number1
Pages (from-to)26-34
Number of pages9
Publication statusPublished - Feb 2022


  • cornea
  • corneal endothelium
  • corneal thickness
  • smoking
  • tobacco


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