BACKGROUND: Cigarette smoking has long been acknowledged as a major risk factor for many of the leading causes of death. Its role in ocular disease has received far less attention. METHODS: This article reviews a large number of recent studies that have investigated a possible link between cigarette smoking and two major causes of blindness--cataract and age-related macular degeneration. RESULTS: The preponderance of evidence shows a causal relationship between cigarette smoking and both cataract and age-related macular degeneration. CONCLUSIONS: As primary eye care providers, optometrists should educate patients regarding the dangers of smoking as it relates to ocular health and consider a role in discouraging patients from starting or continuing this harmful habit.