Myopia Profile


Can exposure to digital screens cause ocular surface disorders in children?

Posted on January 23rd 2023 by Ailsa Lane

Paper title: The Effects of Daily Digital Device Use on the Ocular Surface in Healthy Children

Authors: Burcu Kazanci (1), Fatma Corak Eroglu (1)

  1. Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey

Date: Feb 2022

Reference:  Kazanci B, Eroglu FC. The Effects of Daily Digital Device Use on the Ocular Surface in Healthy Children. Optom Vis Sci. 2022 Feb 1;99(2):167-171 [Link to abstract]


This cross-sectional observational study of 200 healthy children aged 10 to 18yrs investigated how long children spent using digital devices and the effect of prolonged exposure to digital devices on the tear film and ocular surface.

After daily screen exposure times had been assessed, the effects of screen time for those who spent less than 2hrs daily were compared to those who spent more than 2hrs daily.

The tear film of each participant was assessed by measuring tear break-up time, Schirmer test and kerato-epitheliopathy (Oxford) score.  Subjective dry eye symptoms were measured using the Ocular Surface Disease Index (OSDI).

The mean age of the children was 14yrs and 88.5% of them used a mobile phone or a computer daily.

The mean tear breakup times, Schirmer test scores and Oxford scores were 10.3 seconds, 15.6mm and 0.4, respectively.  No corneal staining was found for 83.5% of the cohort.

An average OSDI score was 23.5 with 67.5% of the children showing symptoms of a mild to moderate surface disease.

There was no statistically significant difference found in the values for tear break up, Schirmer test or the OSDI and Oxford scores when the screen time was below or above 2 hours. There was a statistically significant but weak correlation between the time spent in front of screens and the OSDI score only.

What does this mean for my practice?

Children increasingly use digital screen devices as part of their daily lives

  • Even healthy children may develop symptoms of ocular surface disorder, dry eye or digital eye strain with long periods of device use, even if there no clinically apparent signs of dry eye
  • OSDI scoring which suggest mild to moderate symptoms, or worse, may be indicative of future issues with prolonged screen time.

Eyecare practitioners can educate parents and children on this possibility and encourage healthy use of screen time with regular breaks to support general and ocular health.

What do we still need to learn?

Further research could help establish ideal screen exposure times in reference to ocular signs and symptoms. This would allow devices to be used for schoolwork and leisure time, without inducing symptoms of ocular discomfort.

There may be confounding environmental or other factors which could contribute to ocular discomfort alongside screen time. Since digital eye strain symptoms can be due to range of eye conditions from dry eyes to binocular vision dysfunction to glare sensitivity, research relating duration of screen time to these specific clinical findings would further support guidelines for use.


Title: The Effects of Daily Digital Device Use on the Ocular Surface in Healthy Children

Authors: Burcu Kazanci, Fatma Corak Eroglu

Purpose: We aimed to evaluate the duration of screen exposure and its effect on the ocular surface in healthy children aged 10 to 18 years.

Methods: This cross-sectional observational study included 200 healthy children. Screen exposure times of the children were ascertained, and the effect of screen exposure on the ocular surface was evaluated using tear breakup time, kerato-epitheliopathy (Oxford) score, and Schirmer test. The Ocular Surface Disease Index (OSDI) was used to assess subjective dry eye symptoms. Findings for subjects with a daily screen exposure time of fewer than 2 hours were compared with those reporting more than 2 hours of screen time. Statistical evaluation included the Shapiro-Wilk test, Student t test, and Pearson correlation analysis.

Results: The mean ± standard deviation (SD) age was 14 ± 2.6 years, and 88.5% of the participants used mobile phones or computers every day. The mean ± SD tear breakup time was 10.3 ± 4.1 seconds, and the Schirmer test score was 15.6 ± 4.7 mm. The Oxford score was 0.4 ± 1, and no corneal staining was detected in 83.5% of the subjects. The mean ± SD OSDI score was 23.5 ± 17.8, and 67.5% of subjects had a mild-to-severe ocular surface disease. When daily screen exposure times less than and greater than 2 hours were compared, there was no statistically significant difference between the two groups in tear breakup time, Schirmer test, Oxford score, and OSDI score. Whereas there was a statistically significant weak positive correlation (r = 0.307, P = .001) between OSDI score and screen exposure time, there was no correlation between tear breakup time, Schirmer test, and Oxford score and screen exposure time.

Conclusions: Screen exposure in healthy children may cause ocular surface symptoms without causing changes in ocular surface findings.

[Link to abstract]

Meet the Authors:

About Ailsa Lane

Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.

Read Ailsa's work in the SCIENCE domain of

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