Extended Screen Time in Youth Linked With Dry Eye Disease Symptoms

Brothers and sister on sofa with digital tablets and mobile.
The study suggests developing official guidance on safe screen use to help prevent the degradation of ocular surface health.

Long-term extended screen time is associated with more symptoms of dry eye disease (DED) in young patients, according to research published in Contact Lens and Anterior Eye.

The study adds to the evidence indicating that increased screen time during childhood is linked with myopic progression and ocular surface changes that may increase the risk and severity of DED. Prior research has indicated that altered spontaneous blink rates impact tear film stability, aqueous evaporation, and osmolarity; however, few studies have been conducted in real-world settings, the investigators report.

The researchers asked 456 attendees (mean age 24±10 years, 38% women and girls) of a gaming convention in New Zealand to self-report screen use (computers, smartphones, tablets, virtual reality sets), gaming habits, dry eye symptoms, and quality of life for vision-related tasks. The participants completed the Dry Eye Questionnaire-5 (DEQ-5) and the Symptom Assessment in Dry Eye (SANDE) questionnaire. The investigators covertly recorded spontaneous blink rates using the Apple iPad camera that the participants used to complete the surveys and analyzed the blink dynamics with machine learning algorithm software that classified blinks. Participants completed a “blink test” in which they intentionally blinked and then kept their eyes open for as long as they could or until they experienced discomfort. The interval of the test, which was taken 3 times, was averaged.

Median screen time per week was 40 hours (Kolmogorov-Smirnov D=0.08 P =.004). The male participants spent more time gaming compared with the female participants (median 14 hours vs 6.5 hours for female participants, P <.001). Total screen time increased with more gaming hours (r=0.613 P <.001) and age (r=0.125 P <.007) but gaming hours and age were inversely associated (r=-0.264 P <.001).

DEQ-5 was at least 6 for 90% of participants, and 24% of individuals (all with DEQ-5 of at least 6) had blink test results less than 10 seconds, which suggested reduced tear film stability. Of the one-third of participants who were children, 24% had symptoms of DED and 23% had blink test results under 10 seconds. Girls tended to have more discomfort compared with boys (P <.001). Discomfort was linked with extended screen time solely in female participants.

Individuals with faster blink rates and shorter blink test times tended to have more symptoms of DED, and those with more screen time tended to have faster blink rates and more symptoms. The blinks per minute rate was associated with DEQ-5 score (P =.019). Stare time and DEQ-5 were negatively correlated (P =.012). Shorter blink test times were linked with higher blink rates (r=-0.11 P =.02).

Limitations include inability to establish causation and the possibility that the blink test was seen as a competition of ability to stare for a length of time.


Muntz A, Turnbull PRK, Kim AD, et al. Extended screen time and dry eye in youth. Cont Lens Ant Eye. Published online November 25, 2021. doi:10.1016/j.clae.2021.101541