Hookah And Chewing Tobacco — The Impact Of Tobacco On Eye Health

(By Dr. Saugata Poddar)

Hookah and chewing tobacco have long been embedded in Indian culture. Whether it is the leisurely puff of a hookah in a village courtyard or the easy accessibility of gutkha and khaini across local shops, these forms of tobacco use are often seen as less harmful than cigarettes. While most people understand the risks tobacco poses to the lungs or heart, very few realize its silent yet significant impact on vision and overall eye health.

As an ophthalmologist, I have witnessed firsthand how tobacco-related damage manifests in the eyes - often going unnoticed until irreversible harm has occurred. This World No Tobacco Day, let us shed light on the visual consequences of these traditional habits.

ALSO READ: World No-Tobacco Day 2025 — History, Significance, And All You Need To Know About This Day

What These Habits Involve:

Hookah, also known as shisha, involves smoking flavored tobacco through a water pipe. It is commonly misperceived as being safer than cigarettes because the smoke is passed through water. However, studies show that a one-hour hookah session can expose users to more smoke and harmful toxins than multiple cigarettes.

Chewing tobacco, in forms like gutkha, khaini, zarda, and pan masala, is widely used across India. These products contain a mixture of tobacco, areca nut, lime, and other additives—many of which are carcinogenic and toxic to nerve and blood vessels, including those connected to the eyes.

The belief that hookah and chewing tobacco are "less harmful" is a dangerous myth. These forms deliver nicotine and toxic chemicals that are equally - if not more - damaging than cigarette smoking, particularly when consumed habitually over time. 

How Tobacco Damages Eye Health

Tobacco use - whether smoked or chewed - has several ways of affecting vision:

  • Cataracts: Smokers are at significantly higher risk of developing cataracts, a leading cause of blindness in India
  • Dry Eye Disease: Tobacco reduces tear production and destabilizes the tear film, contributing to dryness, irritation and blurred vision. The irritation caused by smoke can exacerbate dryness, leading to redness and discomfort that may force you to remove your contact lenses more frequently if you wear.
  • Age-Related Macular Degeneration (AMD): Tobacco accelerates degeneration of the macula, the part of the retina responsible for sharp central vision.
  • Diabetic Retinopathy and Retinal Vascular Occlusions and Uveitis: Smokers who also have diabetes risk getting diabetic retinopathy. Diabetic retinopathy is when blood vessels in the eye are damaged. The inflammatory and vascular effects of tobacco can trigger these serious conditions, sometimes with sudden vision loss.
  • Thyroid Eye Disease/ Graves Disease: Smokers with TED risk worsening their eye condition (bulging eyes) with smoking.
  • Harm In Your Baby’s Eyes: Smoking during pregnancy increases your risk for giving birth too early. Premature birth can lead to a serious eye problem called “Retinopathy of Prematurity.” The baby may have permanent vision loss or blindness. Children are particularly vulnerable to the effects of second-hand smoke, as their developing bodies and eyes are more susceptible to harm such as Amblyopia (lazy eye) and Strabismus (crossed eyes)
  • Optic Neuropathy and Glaucoma: Nicotine constricts blood vessels reducing blood flow to eyes. Tobacco toxins from long term smoking can damage the optic nerve, leading to progressive and often permanent vision loss.

What Symptoms To Watch Out For

Individuals who regularly use hookah or chew tobacco should be vigilant for early warning signs such as:

  • Blurry or fading vision
  • Difficulty seeing in dim light
  • Persistent eye redness or discomfort or headache
  • Flashes, floaters or sudden loss of vision in one eye
  • Increased sensitivity to light
  • Dry, gritty or burning sensation in the eyes

These symptoms warrant immediate consultation with an eye specialist. Early detection can sometimes prevent permanent damage.

What People Should Do

It’s important to recognize that no form of tobacco use is safe for your eyes. Traditional practices like hookah or chewing tobacco may seem socially or culturally benign, but their cumulative harm - especially on vision - is deeply concerning.

Dr.Saugata Poddar is Consultant Ophthalmologist, at Disha Eye Hospitals

[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]

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