Digital Screen Use Associated With Dry Eye Disease, Especially in Youths

As digital screen use increases, the risk of dry eye disease (DED) increases, and eye care professionals should encourage their patients to engage in prevention strategies, researchers surmised in a literature review published in Clinical Ophthalmology.

The investigators reviewed the literature in MEDLINE/PubMed that discussed DED’s association with digital screen use and blinking dynamics, DED’s impact on quality of life of digital screen users, and strategies digital screen users can employ for preventing DED.

They found that digital screen use exposure was linked with diagnosis of DED and evaporative DED in office workers. In pediatric patients, smartphone use, but not computer or television use, was linked with DED. Tear breakup time decreased with increased computer use. Some evidence suggests longevity of digital screen use is linked with aqueous deficiency and that tear mucin concentration is inversely correlated with daily digital screen use, they reported.

“Reading on a computer resulted in lower tear meniscus height, higher osmolarity, and greater conjunctival redness compared to reading on a smartphone, possibly because reading on a smartphone was associated with a lower gaze angle and lower extent of exposed ocular surface,” the investigators report.

In individuals diagnosed with DED, increased digital screen use was linked with shorter tear breakup time, deteriorated meibum expression, and higher corneal fluorescein staining, OSDI scores, lid margin abnormality, and meibomian gland loss, a study reported.

Reduced blinking rate and blink completeness may be culpable for the association, they reported. Blinking increases evaporative loss and ocular surface dryness. Blink rate and completeness decreases during active tasks on computers and is comparable with blink rate for reading printed material, they discovered. 

Resting the eyes, blinking exercises, and following the 20-20-20 recommendation may help prevent DED, according to the researchers,  although current research does not show the utility of the 20-20-20 rule. 

Using desktop humidifiers was linked to tear breakup time and comfort and wearing virtual reality headsets, compared with conventional computer use, was associated with improved tear film lipid grade, lipid layer thickness, and tear breakup time.

The investigators urged optometrists to discuss with their patients the use of preservative-free tear supplements and healthier habits for using digital screens. Lifestyle changes may include deliberate full blinking exercises, frequent breaks, and reduced use of digital screens. They can encourage their patients to adjust their digital screen use through improving contrast and glare, increasing font sizes, and looking downward at the screen. Regular follow-up and proactive management strategies, including ocular therapies, may be necessary.

“Patients are likely to only implement such strategies if they understand the relationship between dry eye and digital screen use and are aware of such strategies,” the research says. “Therefore, it is essential that clinicians educate patients on the potential negative effects of digital screen use on the ocular surface and possible preventative strategies, especially with patients who are at risk and who already report dry eye symptoms.”

Optometrists must ensure they accurately diagnose DED and its severity and presentation in patients with clinical signs, according to the study. Tests and surveys can rule out other conditions and identify comorbidities.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical and/or device companies. This research was supported by Novartis Pharmaceuticals Corporation. Please see the original reference for a full list of disclosures.

Reference

Al-Mohtaseb Z, Scachter S, Shen Lee B, et al. The relationship between dry eye disease and digital screen use. Clin Ophthalmol. 2021;15:3811-3820. doi:10.2147/OPTH.S321591