The past decade has seen a surge in the use of e-cigarettes, which has prompted the medical community to assess any associated potential health hazards. A major concern was the risk of cancer. Chemical analysis of e-cigarettes has shown the presence of volatile organic compounds with the potential for carcinogenicity. Comparative toxicology analysis has shown e-cigarette to have relatively lower dosages of toxins than conventional combustible cigarettes. Based on comparative analysis, e-cigarettes have been increasingly advocated as a safe alternative to conventional cigarettes. It is vital to recognize that presence of relatively lower toxin level does not preclude carcinogenic potential. The nicotine present in the e-cigarette was presumed to be the major cytotoxic agents, thus nicotine-free e-cigarette was considered as inert. On the contrary, experimental studies on oral cell lines have shown DNA strand breaks on exposure to e-cigarette vapors with or without nicotine. In addition, dysregulations of genes associated with carcinogenic pathways have also been demonstrated in oral tissues exposed to e-cigarette vapors. Despite alarming molecular data, the oral carcinogenic potential of e-cigarette remains unclear, which can be attributed to the lack of long-term prospective and large-scale case-control studies. As e-cigarette users often have other well-established risk factors (conventional cigarette smoking, alcohol, etc.) as associated habits, it is difficult to assess e-cigarette as an independent risk factor for oral cancer. Thus, the present manuscript aims to review the published literature using the Brad Ford Hill criteria of causation to determine the oral carcinogenic potential of e-cigarettes.

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A B S T R A C T BACKGROUNDAmblyopia means "dullness of vision". There should be a minimum of 2 lines visual acuity fall on Snellen visual acuity chart compared with normal eye. Strabismic amblyopia is defined as amblyopia resulting from strabismic disorder without any other co-existing amblyogenic factors. It is assumed that 2-2.5% population has incidence of amblyopia. Amblyopia causes an important socioeconomic problem, especially in children, since the risk of the amblyopic patient becoming blind is significantly higher than in general population. Among all amblyogenic factors, strabismic disorder plays an important role. Since early diagnosis and proper treatment for eliminating causative factors of amblyopia like strabismus play a pivotal role in preventing in strabismic amblyopia, we wanted to determine the various etiological and clinical factors of strabismic amblyopia in children. METHODSThis observational study was conducted among 135 cases of strabismic amblyopia, over a period of 1 year. Children in the age group of 4-15 years who were diagnosed as strabismic amblyopia after compressive ophthalmic examination, orthoptic evaluation, cycloplegic evaluation and fundus examination were included in the study. Data collected included age, sex, detailed history of delivery and consanguinity with regard to the onset of squint, type of deviations, duration of symptoms, family history of squint and usage of spectacles. RESULTSOut of 135 cases of strabismic amblyopia, 71 cases (53%) were male and 64 cases (47%) were female, esodeviations are more (68%) than exodeviation (16%), unilateral cases are more with large angle of deviations and some cases are associated with severe amblyopia. Stereopsis decreased in more number of cases with esodeviations and few eccentric fixation cases were also noted. All demographic, statistic, etiological and clinical features were statistically analysed and presented. CONCLUSIONSAmblyopia with large angle of esotropia is a common cause for strabismic amblyopia. Subjective visual and psychological functions are altered in these patients compared with normal population. With loss of binocularity, day by activity will be affected seriously and occupational hazards may occur during work. So, early detection and treatment is the key for the prevention of strabismic amblyopia.

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