الفهرس 
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Abstract
The ocular surface consists of cornea, conjunctiva, eyelids, eyelashes, and meibomian glands, main and accessory lacrimal glands and tear film. The tear film plays an important role in nutrition, lubrication and protection of the ocular surface and in clear vision. Dry eye is one of the most common ophthalmic problems characterized by a vicious cycle of tear film instability, hyperosmolarity, chronic inflammation, and neurosensory abnormalities, which subsequently leads to ocular surface damage. And associated with symptoms of burning, itching, redness and blurring of vision. Cigarette smoke is already known as an important source of toxic chemical substances and heavy metals. It has been shown to be a risk factor several ocular diseases such as age related macular degeneration, cataract and Graves’ ophthalmopathy. It also has been reported to be one of the important factors causing a dysfunctional tear film and leading to dry eye. The aim of this study was to evaluate the ocular surface changes among smokers. The study included 100 cases (55 were smokers and 45 were nonsmokers), their age ranged from 20 to 51 years old. All cases completed the OSDI questionnaire and routine full ophthalmological examination was done together with Schirmer test, TBUT test, TMH measurement and ocular surface staining with fluorescein, Rose Bengal and Lissamine Green stains to all the cases. This study showed increase in the severity of dry eye symptoms in smokers more than non-smokers, values of Schirmer test and TBUT test and TMH were less in smokers than non-smokers. Also this study revealed that ocular surface staining scores were increased in smokers than non-smokers. This indicate that dry eye is more severe in smokers and there is a certain amount of tear film instability and decreased tear production in smokers.