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At the periphery, the production of neopterin and nitric oxide during inflammation consumes tetrahydrobiopterin to the detriment of the hydroxylase enzymes that use this compound as a cofactor.[ref] Genetic variants can also significantly influence BH4 levels when the body is under stress

Current smokers had a lower odds of glaucoma compared to non-smokers (OR=0.61, 95% CI=0.410.88, P =0.009), and ex-smokers (OR=0.46, 95% CI=0.280.76, P =0.002)

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