Dry Eye Symptoms Exacerbated By Increased Video Display Terminal Use

This photo taken on October 15, 2020 shows children watching television at their home in a village in Siem Reap province. – Trapped under a mountain of crippling debt, a Cambodian farmer fears she will have to sell her land to repay microfinance loans that have ballooned due to pandemic-spurred job losses in her family. (Photo by TANG CHHIN Sothy / AFP) / TO GO WITH AFP STORY CAMBODIA-HEALTH-VIRUS-ECONOMY-MICROFINANCE-DEBT,FOCUS BY SUY SE (Photo by TANG CHHIN SOTHY/AFP via Getty Images)
Researchers conducted a dry eye disease survey among students and teachers across 46 schools to assess video display terminal use during the COVID-19 lockdowns.

An increase in visual display terminal (VDT) use during the COVID-19 pandemic lockdowns created a rise in dry eye symptomatology among school students and teachers, according to research published in the Medical Journal Armed Forces India. Individuals who used television as their primary digital device were more asymptomatic than those who used smartphones, laptops and tablets. 

Researchers administered an online dry eye disease questionnaire to 3327 individuals (students, 3096; teachers, 130; 52.5% men) across 46 schools. Participants reported average screen time, VDT type, and break frequency, and subjectively reported the severity of dry eye symptoms on a scale of 0 to 3 (0, asymptomatic; 3 severe). Among the respondents, 64.5% used smartphones, 23.7% used laptops, 23.7% used tablets, and 5.5% used television as their preferred VDT.

Participants reported a marked increase in cumulative screen time during the COVID-19 lockdown. Overall, there was a threefold increase in the number of participants with a cumulative screen time of 6 hours or more compared with VDT use before the pandemic (6.7% to 23%). 

Teachers reported worse dry eye disease symptom scores compared with students. An overall symptom score of 0 was noted in 40.6% of students compared with 8.5% of teachers (P <.001), while a symptom score of 3 was recorded in 3.4% of students and 7.7% of teachers (P <.010). 

A total of 31.6% of participants took 2 to 5 minute breaks every 30 minutes, 20.2% took breaks longer than 5 minute every 30 minutes, and approximately half did not follow any consistent schedule of long or short breaks. 

An overall score of 0 was noted in 62.1% of participants who used television as the most viewed device, compared with 40.5% of smartphone users, 32.7%, of laptop users, and 31.5% of tablet users ( P <.001). 

“High cumulative screen time and uninterrupted viewing of VDTs, be it for recreational purposes or academic activity, are significant risk factors for symptomatic dry eye disease among school teachers and school students, as reaffirmed by this study,” according to the researchers. “School administrators and policymakers should pay due attention to institutionalizing the guidelines about class duration, appropriate screens, and stipulating break duration during online classes, which will continue to remain the predominant mode of education for teachers and students alike, at least in the near future.”

Study limitations include the absence of objective tests to evaluate dry eye symptomatology.


Rao BV, Bandopadhyay S, Sharma VK, Mishra A, Ambiya V, Sharma N. Dry eye disease survey among schoolteachers and children using visual display terminals during COVID-19 lockdown-CODE study (Covid and dry eye study). Med J Armed Forces India. Published online August 1, 2022. doi:10.1016/j.mjafi.2022.04.014