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How excessive screen time impacts meibomian glands

 Posted on January 23rd 2023 by Connie Gan

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Children are increasingly using electronic devices for both education and leisure. Studies have shown a correlation between increased screen time and myopic incidence and its progression.1 It is a known fact that spending more time on electronic devices is associated with dry eye.2 TA shares a case of a meibomian gland dysfunction which may be caused by increased screen time. Here is the case.

TA Not quite myopia, but it seems that most myopic kids have dry eyes. This is one of a fraternal twin pair, each of whom play video games on their phones 22/7, so not quite 24/7. The dad said there's nothing else to do during Covid. What make it a MICOW (Marginally Interesting Case of the Week) is that one of these boys has absolutely zero meibomian glands. I suppose it is not known whether there are kids who start out with less or zero glands or if they are always lost in the usual fashion, just in an accelerated way due to poor blink behaviour. I do always make it a point to mention dry eyes in every myopia lecture that I do as I think optometry has a twin responsibility to reduce axial elongation and to slow the loss of meibomian glands, as each are irreversible.236888509_10219984259621428_3392509085297365998_n-1024x512.jpeg

Digital screen time and meibomian glands

Meibomian glands secrete meibum to reduce tear evaporation. The blinking motion serves as a pumping force that releases meibum. Studies have shown that meibomian gland dysfunction and screen time are correlated. However, the severity of meibomian gland dysfunction varies between studies. Cremers et al showed that excessive electronic screen use is associated with severe meibomian gland atrophy. Of the children with severe melbomian gland atrophy, 86% were reported to engage in more than 4 hours of daily screen time and 50% of them more than 8 hours daily.3

On the other hand, Kocamis showed weak but significant positive correlation between loss of meibomian gland area, meiboscore for gland atrophy, meibomian gland tortuosity and screen time.4 It is worth noting that meibomian gland atrophy can present as asymptomatic among the pediatric population.4

Other than affecting meibomian glands, increased screen time exposure can also affect the tear film and the ocular surface. Reduced blink rates whilst engaging in near tasks can cause excessive tear evaporation. Studies show that the first hour of smartphone gaming does not impact the tear film function, but that dry eye symptoms escalated in the subsequent hours.5,6

What can we do?

Providing advice to parents and young patients on managing screen time is important for myopia and ocular health. From the point of view of childhood development, physical and mental health, the American Academy of Paediatrics and the Australian Government Department of Health have suggested:

  • Children under two should not have exposure to screen time
  • Children aged from 2-5 should have less than 1 hour of screen time daily
  • Children age from 5-17 should have no more than 2 hours of recreational screen time per day.

For more detail on the 'why' of these guidelines, and support on clinical communication, check out our article Screen Time Guidelines For Children – Resources For Eye Care Practitioners.

Take home messages:

  1. Excessive screen time can cause meibomian gland dysfunction, atrophy and tortuosity, affecting tear film function and the ocular surface.
  2. It is important to take all opportunities to advise young patients and their parents about managing their screen time, to support good vision and ocular health.
  3. Once meibomian glands are lost they cannot be recovered, so proactive clinical management is imperative.

Further reading

Meet the Authors:

About Connie Gan

Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

Read Connie's work in many of the case studies published on MyopiaProfile.com. Connie also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

About Kimberley Ngu

Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Read Kimberley's work in many of the case studies published on MyopiaProfile.com. Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

This content is brought to you thanks to unrestricted educational grant from

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