Abstract:Tobaccoconsumption is one of the leading causes of disease, disability, and prematuredeath but very little is known about its deleterious effect on the ocularhealth of workers handling tobacco. The goal of this study is to identifyprobable effects of occupational tobacco exposure among Indian Bidi industryworkers. This study included 310 females (mean age, 34.

8 ± 10.9 years) activelyperforming bidi-rolling presenting eye symptoms to a tertiary eye carehospital. Results suggested that a wide spectrum of ocular complications existedamong these workers. Some of the very common ocular symptoms were – defectivevision, dull-aching headache and eye irritation. The major ocular findings werepapillary conjunctiva hyperplasia, hyper-pigmentation of ocular surface, punctuateepithelial erosion or superficial punctuate dermatitis, cataract orpseudophakia and segmental optic atrophy. Abstaining from such kind of work,supplementation of Vitamin B complex rich in B 12 and appropriatesurgical & medical management reversed visual loss due to corneal diseaseor cataract but was not effective in optic neuropathy.Introduction:Tobaccorelated industries are one of the major commercial enterprises around theworld. Over the years, both production and consumption of tobacco products hasincreased alarmingly throughout the entire world.

In India, around more thanfive million individuals are involved in the production of Bidi. Theseindividuals either work in small factories or at household based enterprises inan environment confined with tones of tobacco dust. Individuals there working 6to 10 hrs/day inhales, swallows and exposes their skin and mucous surface tosignificant amounts of particulate tobacco. Thetoxic constituents of tobacco gets absorbed & accumulated into the body,gets bio-activated leading to increased risk of developing diseases for whichtobacco consumption is the sole risk factor, including chronic obstructivepulmonary disease, cardiovascular system abnormality, carcinomas and prematuredeath. Although the potential & chances of the above mentioned diseases mainlyexists among the workers of the tobacco industries, very little information isavailable about the adverse ocular health effects of this exposure among Bidi workersas well.

The sole objective of our study is to gain more & more informationabout the probable effects of tobacco dust on the ocular health of Bidi-rollers.Material and methods:Thishospital based observational case study was conducted at a tertiary eye carecenter located in India. The subjects of concern enrolled (n = 310) females, who wereactively involved in Bidi-rolling procedure and were presented at outpatientdepartment with many ocular complaints.

After obtaining/gaining informedconsent, questionnaire about type & quality of work, eye symptoms, andsmoking and alcohol habits, general health was completed for each subject.Complete ocular examinations including color vision and visual field testingwas performed to identify any anterior or posterior segment pathology. Also, Hemoglobinwas estimated by digital colorimeter as an indicator of general health for allpatients.Stastical methods:Clinicalfeatures related to ocular complaints of patients, noticed or aggravated afterworking at Bidi-rolling were tabulated for clinical analysis. Results arepresented in the form of percentage, means and standard deviations. Pearsoncorrelations of age, levels of hemoglobin, and total amount of work done inyears with equivalent decimal best corrected visual acuity (BCDVA) in arandomly selected eye were also studied & reviewed to mark any significantassociation between age, general health, work & eye diseaseResult:Thedemographic details and systemic features of 310 patients were studied &provided. The patients were estimated & guessed to have rolled on anaverage three million bidis/person in their life at the time of presentation.

All such patients belonged to the poor socioeconomic strata. Their meanhemoglobin was 10.2 ± 1.5 gm% (range, 6.1-2.9). There was no significantcorrelation between hemoglobin levels and the amount of work they did (P = 0.

079), patient age (P = 0.055) or BCDVA (P = 0.098).Chiefocular complaints were defective vision (n = 195, 62.

9%), constantdull-aching headache (n = 166, 53.6%) and irritation/foreign bodysensation (n = 118, 38.1%).

Main clinical features observed werepapillary Conjunctival Hyperplasia (n = 304, 49.0%), increasedpigmentation of Conjunctival and/ or corneal surface (n = 89, 14.4%), PunctuateEpithelial Erosions (PEE) or Superficial Punctuate Keratitis (SPK; n =40, 6.5%), cataract or pseudophakia (n = 68, 10.9%) and Optic Neuropathy(n = 121, 19.5%).Bestcorrected visual acuity (BCVA) of 145 eyes (23.

4%) was < 20/20. Opticneuropathy (n = 58, 40.0%), cataract (n = 46, 31.7%) and cornealdisease (n = 19, 13.1%) were the main found causes of visual functionloss. Decimal best corrected visual acuity had a significant negativecorrelation with the amount of work (correlation ?r? = -0.

267, P<0.001) and the patient age (r = -0.304, P < 0.001) suggestingthat increasing duration of work and age were related with poor visualfunction.

Intramuscularand oral vitamin supplements which are rich in B12 (such asNeurobion forte injection twice a week for one month or one tablet daily ofvitamin B complex with B12, Merck Limited, India) administered/ usedregularly for one month showed quite a lot of improvement in visual functionsin cases of corneal involvement but were not significantly effective inreversing visual loss due to optic neuropathy.Discussion:Aswe all know that Bidi manufacturing is one of the second largest employmentsgenerating feasible work industry in India. It provides employment to millionsof women and children belonging mostly to the poor socioeconomic strata.Investigations also cleared that that these tobacco-processors are exposed& prone to extremely high levels of inspirable tobacco particulates &dust.

Considering the high content of nicotine and other toxic chemicalsin Bidi tobacco, these poor workers are at an extremely alarming risk ofdeveloping death causing systemic illness. Nicotine is one of the majorcomponents of tobacco, and has potential adverse health consequences. Inaddition to this, tobacco has around 4000 active chemical compounds among whichmore than 50 are carcinogenic & the list includes nitrosamines, polycyclicaromatic hydrocarbons, radioactive elements, and cadmium.Eye getstargeted secondary to generalized toxic levels of these harsh chemicals in thebody, or from direct exposure of the ocular surface to the dust-ladenenvironment. Direct exposure may lead to problems like: painful stimulation ofconjunctival and corneal nerve endings, development of papillary conjunctivalreaction, chromosomal damage, metaplastic change, death and erosion of ocularsurface cells and deposition of melanin pigment on the surface. Nutritionaldeficiency & lack among those poor workers can be considered as animportant etiological factor as most of our patients belonged to the poorsocioeconomic strata. Otherwise Nicotine and other vaso-active compounds inducevasoconstriction of posterior ciliary arteries and produce atheroscleroticplaques of the carotid artery system.

These lesions are responsible for retinalischemic attacks and anterior ischemic optic neuropathy resulting in causingvisual loss that does not even recover with oral nutritional supplementsintake.Our findings& study raise various concerns about the potential occurrence of oculardiseases and systemic co-morbidities among Bidi-rollers. Considering that theIndian Bidi-industry is an unorganized, underdeveloped & neglected manufacturingsector, and that >15 to 25% of employed workers are either children below 15years or women, the effect of tobacco on physical and ocular healthin coming future may be at alarmingly high rate. Interventions are requirednecessarily to minimize tobacco exposure, create awareness about the diseasescaused and extend medical help/support to minimize & lessen the deleteriouseffect of tobacco on Bidi-rollers.Reference1.

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