Ocular Surface Symptoms Linked With Screen Exposure in Children, Tear Parameters Unaffected

Students using computers in classroom
Clinicians should be aware that ocular surface symptoms may not always correlate with objective ocular surface findings, and not overlook screen exposure symptoms in children.

Ocular surface symptoms are likely associated with screen time in healthy children despite a lack of correlations with objective dry eye parameters, according to a study published in Optometry and Vision Science.

Researchers conducted a study of children (N=200, mean age, 14±2.6 years) presenting to a single center ophthalmology clinic for a routine eye exam. They measured tear breakup time (TBUT), performed a Schirmer test, administered the ocular surface disease index (OSDI), and collected data on participants’ reported mobile phone and computer usage. Researchers included patients with a visual acuity of at least 20/25 (Snellen chart without refractive correction) and divided them into 2 groups based on daily digital device exposure. Group 1 consisted of those who used digital devices less than 2 hours per day, while group 2 included children with greater than 2 hours of exposure per day.

Mean OSDI score for the cohort was 23.5±17.8 (21.5±16.7 and 24.4±18.5 for groups 1 and 2, respectively) revealing a weak, but statistically significant correlation between OSDI score and screen exposure (r =0.280 P =.001). However, researchers did not note any statistically significant associations between groups 1 and 2 with respect to TBUT (P =.21), Schirmer test (P =.41), OSDI score (P =.31), or Oxford score (P =.22). 

“Ocular surface symptoms increased as screen exposure increased in children, although the conventional tear parameters were found to be normal,” according to the investigators. “As shown in previous studies, ocular surface symptoms may not always correlate with objective ocular surface findings. Although clinical findings related to dry eye are not detected during routine ophthalmologic examination, questioning this age group about symptomatic ocular surface disorder and possible symptoms related to screen exposure should not be overlooked.”

Limitations of the study included a single center design and the lack of a symptom questionnaire validated for use with pediatric patients.


Kazancı B, Eroglu FC. The effects of daily digital device use on the ocular surface in healthy children. Optom Vis Sci. 2022;99(2):167-171. doi:10.1097/OPX.0000000000001840