Association between Nicotine and Cannabis Use and Ocular Inflammatory Diseases and Complications: Results from the TriNetX Database

Abstract Purpose: To analyze the incidence of ocular inflammatory diseases and related ocular complications in patients with and without a history of cigarette, cannabis, vaping, and chewing tobacco use or exposure to tobacco smoke. Methods: Patients aged 18 years and older with and without a history of cigarette, vape, cannabis, or chewing tobacco use, patients with and without a history of exposure to second-hand smoke, and patients with a diagnosis of an ocular inflammatory disease were included in our study. Odds ratios (ORs) were calculated to analyze the proportion of individuals who developed uveitis, scleritis, ocular mucous membrane pemphigoid (oMMP), and each ocular complication after cigarette, cannabis, vaping, and chewing tobacco use and exposure to tobacco smoke, compared to nonusers or those not exposed to tobacco smoke. Results: Compared to nonsmokers, the OR for developing uveitis was 1.459 times higher for cannabis users ( P = 0.016, 95% confidence interval [CI]: 1.072–1.985) and 1.712 times higher for those exposed to tobacco smoke ( P < 0.001, 95% CI: 1.366–2.146). The odds of developing scleritis were 2.596 times higher for cannabis users ( P = 0.002, 95% CI: 1.389–4.853), 1.667 times higher for vape users ( P = 0.008, 95% CI: 1.14–2.438), and 1.612 times higher for chewing tobacco users ( P = 0.013, 95% CI: 1.102–2.357). The odds of developing oMMP were 1.923 times higher for cigarette users ( P = 0.042, 95% CI: 1.011–3.657). The odds of developing glaucoma were 1.551 times higher for cigarette users ( P < 0.001, 95% CI: 1.234–1.95), 1.547 times higher for vape users ( P < 0.002, 95% CI: 1.223–1.956), 1.574 times higher for chewing tobacco users ( P < 0.001, 95% CI: 1.25–1.982), and 1.707 times higher for those exposed to tobacco smoke ( P = 0.001, 95% CI: 1.229–2.37). Finally, the odds of developing cataracts were 2.513 times higher for cigarette users ( P < 0.001, 95% CI: 1.821–3.469), 1.923 times higher for cannabis users ( P = 0.005, 95% CI: 1.204–3.069), 2.151 times higher for vape users ( P < 0.001, 95% CI: 1.509–3.064), 2.162 times higher for chewing tobacco users ( P < 0.001, 95% CI: 1.525–3.064), and 4.205 times higher for those exposed to tobacco smoke ( P < 0.001, 95% CI: 2.89–6.068). Conclusions: History of cannabis use and exposure to second-hand smoke are significantly associated with an increased risk of uveitis, whereas a history of chewing tobacco, vape, and cannabis use is significantly associated with an increased risk of scleritis. Cigarette use is also associated with a significantly increased risk of oMMP.