The Risks of Secondhand Smoke on Children’s Vision

It is now well known that secondhand cigarette smoke is harmful to health, however, while most people are aware that smoking damages the lungs, few know that it can also be harmful to eye health, especially in children.

Secondhand smoke and visual health: the warning from scientific studies

A recent article published in the scientific journal BMC Ophthalmology()* has once again drawn attention to this issue, emphasizing the importance of protecting children from potential vision damage caused by exposure to cigarette smoke.

Myopia in children: a growing concern

In particular, cigarette smoke contains substances that increase the risk of onset and progression of myopia, a visual impairment that results in blurred distance vision.

Myopia is usually caused by excessive elongation of the eyeball, which causes the images of distant objects and people to fall in front of the retinal plane rather than directly on it, resulting in blurred vision. When the elongation of the eyeball is particularly pronounced, there is also a greater risk for some serious eye diseases, such as myopic maculopathy, posterior staphyloma, age-related macular degeneration, retinal detachment, glaucoma, etc. For this reason, it is important to try to prevent or at least limit the progression of this condition as much as possible.

Genetic and environmental factors in myopia

Myopia has a significant genetic component, but environmental factors also play an important role, and exposure to certain pollutants, such as those present in cigarette smoke, can trigger its early onset and/or accelerate its progression.

Toxic substances in smoke and eye damage

Among the substances contained in cigarette smoke, the most harmful to eye health are carbon monoxide and ammonia, which cause inflammation and oxidative damage to the eye tissues and the oculomotor muscles, leading to inadequate or insufficient control over the growth of the eyeball.

Younger children, greater risk

Children who are exposed to cigarette smoke in their family environment or who spend a lot of time in spaces with smokers have a higher probability of developing myopia compared to children raised in smoke-free environments. This risk is even greater in very young children (early years of life) and in those who already have a genetic predisposition to myopia.

Inflammation and oxidative damage: how smoke alters eye growth

The correlation between myopia and cigarette smoke is attributable to the inflammation and oxidative damage caused by the latter. Inflammation and oxidative stress can alter cellular balance in the eye and lead to an imbalance in eye growth, particularly along the anteroposterior axis of the eyeball.

How to protect children from secondhand smoke

To prevent or at least mitigate the risk of myopia in children—and other eye diseases later in life—it is essential to promote behaviors and policies that help avoid their exposure to secondhand smoke: awareness among adults in private spaces, smoking bans in public areas, and especially education and information about the risks of secondhand smoke on vision are highly desirable.

The role of physicians and society

We ophthalmologists, along with general practitioners and pediatricians, have the duty to promote maximum awareness of the risks of secondhand smoke on the eye health of the youngest, and we wish to highlight the urgent need to protect children by ensuring them healthier and safer environments.

^(*) Lu Y, Li X, Deng Y, Wang K, Li Y, Zhao M. Secondhand smoke (SHS) exposure is associated with an increased risk of developing myopia among nonmyopic children in China. BMC Ophthalmol. 2025 Feb 11;25(1):65. doi: 10.1186/s12886-025-03890-7. PMID: 39930403; PMCID: PMC11812246.

Dr. Jung Hee Levialdi Ghiron
Responsabile comunicazione scientifica Rome Vision Clinic