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A previous study showed a correlation between e-cigarette use and increased symptomatic dry eye and decreased tear film, theorizing that the propylene glycol used as solvent for the e-cigarette liquid produces free radicals which damage the lipid layer of the tear film by lipid peroxidation. In this study, e-cigarette users were found to have lower tear meniscus heights and tear breakup times, which were thought to be from deterioration of the lipid layer, but normal to elevated Schirmer testing indicated increased reflex tearing, the authors noted