With Increased Screen Time, Juveniles Develop More Severe Meibomian Gland Atrophy

Pediatric patients experience more severe ocular surface disease with increased screen time.

Excessive electronic screen use in children may be linked to increased cases of severe meibomian gland atrophy (MGA), according to findings published in the American Journal of Ophthalmology.

“Global lockdowns due to the COVID-19 pandemic have necessitated increased electronic-screen-use (ESU) for work and schoolwork, particularly in children,” researchers explain. They report that the ESU has “surged to all-time highs” and that “the recent increase in the search term “eye pain” is likely a secondary effect representing the rise in global ESU.”

To explore this connection, researchers conducted a retrospective, cross-sectional study that included 41 children between the ages of 6 and 17 years who were evaluated for grade 2 (severe) or higher MGA and age-matched controls with lower than grade 1 atrophy, which is considered insignificant. Of the case group, 86% of children reported >4 hours of daily electronic screen use, and 50% reported >8 hours daily. Control group participants did not exceed 2 hours of daily screen use.

The participants were assessed using questionnaires regarding symptoms, daily electronic screen use hours, diet, and outdoor time. Participants also underwent meibography imaging to identify severe MGA in at least 1 eyelid, and autoimmune disease biomarker positivity was assessed in 16 severe MGA cases.

The study found that 17 participants had severe MGA and 24 controls had insignificant MGA. Of the severe MGA cases, all had ocular signs of dry eye disease (DED) including corneal neovascularization (29%), best-corrected visual acuity loss (41%), and central corneal neovascularization (14%). No control participants had signs of DED, and they had lower meibogrades than the case participants (P <.01). 

The researchers succeeded in finding a positive association between increased electronic screen use and increased meibogrades (95%CI, 1.39 to 5.41). In the 16 participants with severe MGA who underwent assessment for biomarker positivity, 62.5% tested positive, although none had symptoms of systemic MGA (18.8% rheumatoid factor; 6.25% anti-Sjogren syndrome A/B; 31.3% early Sjogren syndrome, 6.25% ANA-positive/RF-negative). A significant association was not found between autoimmune disease biomarker positivity and severe MGA versus controls (P =.34 right eye; P =.71 left eye). 

The researchers note that there may also be a positive association between the consumption of printed material and severe MGA, but since the conditions of usage tend to differ greatly from electronic screens, future studies should investigate this possibility.

“Few children sit for many hours at a time to read a book whereas many view screens/video-games for hours,” the study explains. “Given complex cortical pathways involved in spontaneous and reflex blink in adults and children, future randomized, controlled studies are needed to compare excessive reading to excessive screen use on long-term MGA in children.”

Study limitations include small sample size, as well as its inability to assess meibomian gland morphology.


Cremers S, Khan A , Ahn J, et al. New indicator of children’s excessive electronic screen use and factors in meibomian gland atrophy. Am J Ophthalmol. April 12, 2021. doi:10.1016/j.ajo.2021.03.035