Smoking is a lifestyle risk factor that disrupts ocular surface homeostasis through toxic exposure to the tear film and systemic effects on lacrimal gland function. Objective: To determine the association between smoking intensity and dry eye syndrome among young adult male active smokers. Methods: This analytic observational study employed a cross-sectional design and enrolled 65 subjects (130 eyes) from 297 male students at the Faculty of Medicine, Universitas Islam Sultan Agung. Smoking intensity was categorized into mild, moderate, and heavy. Clinical evaluation included the Ocular Surface Disease Index (OSDI) questionnaire, Tear Break-Up Time (TBUT) test, and Schirmer I test. Data were analyzed using the Chi-square test and Somers’d coefficient (p < 0.05). Results: The mean subject age was 20.02 ± 1.36 years. Dry eye syndrome affected 81 eyes (62.3%). A significant association was found between smoking intensity and dry eye syndrome (p < 0.001), with a moderate strength of association (d = 0.490). Dry eye occurrence increased with smoking intensity: 36.7% in the mild group, 83.3% in the moderate group, and 86.4% in the heavy group. Conclusion: Smoking intensity is significantly associated with dry eye syndrome among young adult male active smokers. Ocular surface disruption was found to worsen as smoking intensity increased. Practitioners should conduct routine screening and provide smoking cessation education from a young age. Comprehensive prevention is warranted, considering the mild group already exhibits a high incidence of dry eye. Keywords: active smokers, dry eye syndrome, ocular surface, risk factor, smoking intensity
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