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Symptoms of DED Have Increased in Pediatric Population Due to Screen Time


A new study has found that prolonged screen time may cause increased symptoms of dry eye disease (DED) in children.

The COVID-19 pandemic is likely to have caused an increase in dry eye disease (DED) symptoms in children due to prolonged screen time, according to a study published in Cureus.

DED is an inflammatory disorder caused by the insufficient production of tears to lubricate the eye. Children have had increasing screen time during school hours due to the COVID-19 pandemic, which has caused them to have increased dry eye symptoms. This study aimed to establish the relationship between screen time during the COVID-19 pandemic and the increasing prevalence of DED symptoms.

A self-administered questionnaire for children aged 10 to 18 years was conducted for the observational cross-sectional study. The questionnaires were given to outpatient pediatric ophthalmology clinics at King Fahd Armed Forces Hospital and King Abdulaziz Medical City from October 2021 to January 2022. All children aged 1 to 18 years were included in the study if they attended the pediatric outpatient clinics.

The Ocular Surface Disease Index (OSDI) questionnaire was used for this study; this measures the severity of symptoms of DED and consists of 12 items graded on a scale of 0 to 4. People with normal eyes would have a score of 0 to 12 whereas severe eyes would have a score above 33.

There were 329 patients who were included in the study, with more than half of them male patients (56.1%) and aged 12 to 18 years (58.5%). A total of 8.8% of participants had chronic diseases and 7.9% used medication daily. Allergic conditions were found in 23.0%, 15.2% of whom used medication. In addition, 8.8% of participants had a medical or surgical intervention for eye disease and 3.9% had an eye surgery within the previous 6 months.

Decreased vision (23.0%) and itchy eyes (22.1%) were the mostly commonly reported symptoms seen with the OSDI questionnaire. Discomfort was found in some participants with mobile device use (27.3%) and reading (20.3%) as DED symptoms persisted. Windy weather (21.8%) and places with air conditioners (15.8%) were top places where participants felt uncomfortable. Other reported symptoms outside of the OSDI included headache/fatigue (26.1%), dry eyes (18.2%), and increased eye discharge (17.6%).

The median (IQR) score for OSDI was 29.2 (12.5-44.3) in all participants. There were 250 patients (7.6%) who had DED based on the OSDI diagnostic criteria, with 44 (13.3%) having mild DED, 62 (18.8%) having moderate DED, and 145 (43.9%) having severe DED.

DED was associated with increasing age: 80.8% in patients aged 12-18 years and 78.2% in patients aged 7-12 years vs 57.6% in the youngest category. Participants with a history of using daily medications had a significantly higher incidence of DED (92.3% vs 74.6%), as did participants with medical/surgical eye treatment (96.6% vs 74.1%), an eye disease (92.7% vs 72.7), conjunctivitis (95% vs 74.8%), dry eye when using electronic devices (97.3% vs 69.7%), and allergies (90.8% vs 71.7%).

People who used eyeglasses were found to have a significantly high incidence of DED vs those not needing glasses (94.1% vs 68%), as didthose who could not close their eyelids (100% vs 75.1%) and participants who used medication for allergies (90% vs 73.6%).

DED was found in 78.1% of participants who had screen exposure of 2 to 3 hours, and screen exposure for 4 or more hours led to 81.8% of participants experiencing DED. A higher proportions of patients had DED (84.4%) if they had TV exposure for 1 to 2 hours compared with those who had zero hours, 2 to 3 hours, and 4 or more hours.

Participants in the older age categories had a higher risk of DED (patients aged 7 to 12 years, odds ratio [OR], 2.79; 95% CI, 1.09-7.12 vs patients aged 12 to 18 years, OR, 3.20; 95% CI, 1.37-7.48).

There were some limitations to this study. Environmental factors affecting the development of DED were not considered, and recall bias was possible with self-reporting. Some children also had difficulty expressing DED symptoms.

The researchers concluded that symptoms of DED increased in children due to prolonged screen time due to the COVID-19 pandemic.


Alnahdi W, Hadrawi M, Danish E, et al. Relationship between screen time and dry eye symptoms during the COVID-19 pandemic in the pediatric population of the western region of Saudi Arabia. Cureus. 2022;14(11):e31015. doi:10.7759/cureus.31015

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