Product profile

Digital device use and dry eye

It’s not just our computers that are streaming, writes Meena Puar, as she reviews the link between screen use and dry eye...

The demands of modern society have resulted in us sitting in front of digital devices for hours and hours. At a touch of the button, we can do anything from ordering our weekly food shop, catching up with friends and family, or watching the latest ‘must-see’ boxsets and film releases. The list is endless. The use of smartphones, tablets and laptops has led to many of us experiencing visual symptoms known as ‘computer vision syndrome’ (CVS), better known now as ‘digital eye strain’.

The common symptoms of CVS listed in Figure 1 may also be linked to environmental factors, such as poor ergonomics, air pollution, improper lighting, glare and decreased humidity in air-conditioned rooms.

SNAPSHOT OF STATISTICS In the UK, digital device use has increased substantially in recent years. A 2016 study revealed that adults typically spent four hours and 45 minutes per day using digital media1. A similar study also showed that all age groups had increased their use of digital devices2. A more recent (2020) crosssectional study by Golebiowsi et al3 revealed that the daily duration of smartphone use correlated with levels of dry eye, confirmed by a dry eye assessment and survey. The latter study involved 916 children with the signs and symptoms of dry eye, which improved after electronic device use was reduced.

During the Covid-19 pandemic, screen time has reached an all-time high, and the impact of this behaviour on ocular surface health has been clearly established4. For some, Zoom meetings have now become part of the norm. From work meetings, home schooling, exercise classes and even virtual birthday parties, the list goes on. In this review, we will take an in-depth look at the relationship between screen use and dry eye disease.

Figure 1. Common symptoms associated with CVS

DRY EYE DISEASE DEFINED Dry eye disease is a multifactorial disease. The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Report5 defines dry eye as: “...a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.”

Approximately one in five adults suffer from dry eye disease, which translates to more than 13 million people in the UK6. Whilst seated in front of the screen for a long period of time, there are two factors that play a part in exaggerating dry eye disease and its symptoms. This includes a reduction in the blinking rate and incomplete blinks.

Firstly, it is important to understand what happens when we blink. During a complete blink, the meibomian glands are activated. These glands line along the edge of the eyelids (Figure 2), and they play a crucial role in producing the oily layer of the lipid component of the tear film. The meibum is released onto the lid margins for dispersion onto the tear film. This combined effort is of the orbicularis oculi and muscle of riolan. During the complete blink pattern, the upper and lower tear film mix.

REDUCED AND INCOMPLETE BLINKS Several studies have documented the link with reduced blink rate and computer use. A study conducted by Patel et al7 reported a mean rate of 18.4 blinks per minute under relaxed conditions, reducing to 3.6 blinks per minute during computer usage. In another study8, blink rates were found to be reduced for all reading tasks, but significantly fewer blinks were noted when patients were reading with backlit LCD screens. Reducing the blink rate can reduce visual quality, giving rise to tear film instability, and consequently lead to dry eye symptoms9 .

If the blinks are incomplete, tears will not distribute over the ocular surface and this results in increased evaporation and an unstable tear film10. In addition to this,

Figure 3. Théa options for dry eye patients

corneal desiccation and contact lens surface dryness may develop. Therefore, in patients who have a reduced blink rate, and those who do not blink fully during digital device use, this gives rise to dry eye symptoms such as grittiness, dryness, burning, etc. One hour of smartphone use has been reported to increase the rate of incomplete blinking from six per minute to 15 per minute11 .

CONTACT LENSES AND DEVICE USE In a survey looking at the use of digital devices and contact lens wearers12, up to 74 per cent of participants reported that they had to remove their lenses when they felt discomfort. This can be solved using lubricating eye drops, which can help the symptoms. Figure 3 shows which products might be suitable for patients suffering with dry eye from the Théa range. All of the products are suitable for use with contact lenses.

TOP TIPS FOR SCREEN USE 1. Whilst using a computer screen or any form of digital device, it is important to incorporate the 20-20-20 rule. This rule recommends spending 20 seconds looking at something 20 feet away for every 20 minutes of screen time. 2. The blink quality and frequency are adversely affected by the increased use of digital devices, so blink exercises are advised for these patients as they have shown to improve dry eye symptoms13 . 3. Discuss environmental factors with your patients too. Offices tend to have low humidity and air-conditioning, which can cause the ocular surface to dry. Therefore, offering advice on increasing humidity levels can help reduce dry eye symptoms and tear film evaporation.

WHY LID CARE IS ESSENTIAL More than 80 per cent of people who complain of dry eye also have inflamed eyelids that need care in addition to dry eye drops14. Therefore, lid care is an essential part of dry eye management. With the demands on digital devices increasing day by day, we will see more patients suffering with digital eye strain and the associated dry eye disease symptoms. It is important for eyecare professionals to keep up-to-date with the latest technology and innovations.

Helping patients suffering from dry eye disease associated with digital devices can start with advice about blinking exercises and even changes in their local environment. The dry eye and lid hygiene ranges from Théa Pharmaceuticals offer a complete solution for mild to severe dry eye and blepharitis – with options to suit different patient needs (unit dose, multidose, wipes, solutions and gels). All of the products in the Théa lid care range (Figure 4) are dermatologically tested.

Blephaclean preservative-free daily eyelid cleansing wipes are suitable for patients from the age of three months, and are clinically proven and recommended by experts. Blephasol , Blephasol Duo and Blephagel are ideal for long-term use – and when used once daily will last for two months.

For more information about the complete range of products, please contact your Thea area sales manager or telephone 01782 381698.

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3. Golebiowski B, Long J and Harrison K et al. Smartphone use and effects on tear film, blinking and binocular vision.

Curr. Eye. Res. 2020;45(4):428-434. 4. Bahkir FA and Grandee SS. Impact of the

Covid-19 lockdown on digital devicerelated ocular health. Indian J.Ophthalmol. 2020;68(11):2378-2383. 5. Craig JP, Nichols KK, Akpek EK, Caffery B,

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Shibata Y and Yamamoto S. Effect of incomplete blinking on tear film stability.

Optom. Vis. Sci. 2013;90:650-7. 10. McMonnies CW. Incomplete blinking: exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses. Contact Lens &

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Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study.

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Effect of povidone 2% preservative-free eyedrops on contact lens wearers with computer visual syndrome: pilot study.

Eye & Contact Lens 2004;30(1):34-39. 13. Kim AD, Muntz A, Lee J and Wang M.

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Eye May 2020 May 12:S1367-0484(20)300 87-4. doi: 10.1016/j.clae.2020.04.014. Epub ahead of print. PMID: 32409236.04.014.

Epub ahead of print. PMID: 32409236. 14. Lemp MA et al. Distribution of aqueousdeficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea 2012;31(5):472-8. PMID: 22378109.

Meena Puar BSc (Hons) MCOptom, FBCLA is sales and education lead for Théa UK.