Elevated Screen Time, Reduced Hours Slept Associated With Dry Eye Disease

Small boy using a digital tablet
Clinicians may wish to consider educating dry eye patients on the potential benefits of increased sleep and danger of increased screen time.

A secondary analysis of a previous study reveals that increased screen time increases the odds of dry eye disease (DED) in children, while increased sleep serves as a protective function against the condition, according to a report published in The Ocular Surface. 

Researchers analyzed 446 eyes of 446 participants (mean age 13±2 years) for dry eye disease. They administered a lifestyle factor questionnaire which asked participants to self-report contact lens use, average hours of daily digital exposure, exercise, outdoor activity, and sleep. They also asked patients to use a 4-point scale to assess diet (1-poor dietary habits to 4-excellent dietary habits), stress (1-low stress to 4-high stress), and health status (1-poor health to 4-excellent health). 

Investigators defined diagnostic criteria for DED as a noninvasive tear film break up (TBUT) time of fewer than 10 seconds and a Dry Eye Questionnaire (DEQ-5) score of 6 or higher. In total, 18% (n=80) of participants received a diagnosis of DED. Median digital screen exposure time for the cohort was 4 hours per day, while median sleep time was 8 hours per day. 

Longer screen exposure time increases the risk of DED (95% CI, 1.02 to 1.29; P =.02), the multivariate logistic regression shows. Each hour of increased screen time equates with a 15% increase in the odds of acquiring DED, according to the report. The study also shows that sleep protects patients against DED (95% CI, 0.58 to 0.91; P =.006), with each hour of increased sleep decreasing the odds of DED by 27%.       

“The association between digital screen exposure and dry eye disease is thought to be mediated by the suppression of spontaneous and reflex blinking during tasks requiring significant levels of cognitive loading and visual processing.” according to investigators. However, they explain, “the precise mechanisms underlying the protective effects of sleep remain yet to be fully understood.”

Study limitations include a single center design, potential volunteer bias resulting from open advertised recruitment, and possible recall bias resulting from self-reporting. 


Wang MTM, Craig JP, Vidal-Rohr M, et al. Impact of digital screen use and lifestyle factors on dry eye disease in the paediatric population: secondary analysis of a cross-sectional study. Ocul Surf. Published online January 31, 2022. doi:10.1016/j.jtos.2022.01.001