DRY EYE IN children is connected to the challenges of increased screen time and myopia risk (Moon et al, 2016; Foreman et al, 2021). New data indicates that the upsurge in children’s screen time during the COVID-19 pandemic has persisted since then.

A new U.S.-based study reported that total non-schoolwork screen time in children aged 4 to 12 years was a mean of 4.4 hours per day pre-pandemic, increasing to more than six hours per day in the first measured “pandemic period” (December 2020 to April 2021) (Hedderson et al, 2021). In the second “pandemic period,” May 2021 to August 2021, screen time remained elevated despite many public health precautions being lifted.

In the eyecare field, excessive screen time raises concern about dry eye disease (Moon et al, 2016) and myopia risk (Foreman et al, 2021). Higher amounts of daily screen time are also associated with less physical activity and sleep and adverse mental health and behavioral outcomes in children (Lissak, 2018). Practitioners have an important role in providing advice about screen time for pediatric patients, considering the potential impacts on ocular, physiological, and psychological health.

There is a volume of evidence linking dry eye disease to digital screen use in both children and adults (Moon et al, 2016; Al-Mohtaseb, 2021; Kocamiş, 2021; Cremers et al, 2021). The hypothesized mechanisms are a reduction in blink rate and completeness and a deterioration in tear film quality (Al-Mohtaseb, 2021).

One study that investigated children aged 5 to 18 years without any previous history or symptoms of dry eye disease found correlations between increased screen time and loss of meibomian gland area, gland atrophy, and tortuosity (Kocamiş, 2021). Average screen time exceeded 29 hours per week, ranging from seven to 70 hours. Over 90% of the children studied showed some evidence of meibomian gland atrophy.

Another study of children (6 to 17 years) who had severe meibomian gland atrophy found that 86% reported at least four hours per day of screen time while 50% reported more than eight hours (Cremers et al, 2021). None of the control group, who had normal ocular health, reported more than two hours per day of screen time.

These findings point toward a future epidemic of dry eye disease to match the growing epidemic of myopia (Holden et al, 2016). Children who have signs of dry eye report fewer symptoms than adults (Han et al, 2013), potentially complicating diagnosis and proactive clinical care of dry eye in the pediatric population. Coupled with the well-known loss of meibomian gland structure and function with age (Knop et al, 2011), the adults of tomorrow are at elevated risk of suffering the negative quality of life and visual function effects caused by dry eye disease (Guo and Akpek, 2020).

What can we do now? Recognition of screen time as an influential factor in childhood visual development and ocular health points to proactive clinical evaluation. It is crucial to provide advice to parents and young patients on managing screen time and reestablishing healthy screen habits after the pandemic.

The American Academy of Pediatrics Family Media Plan tool provides practical guidance for parents, underpinned by a recommendation to limit sedentary screen time to two hours per day in school-aged children (Hill et al, 2016). The World Health Organization recommends no exposure to screen time for those under 2 years old, and no more than one hour per day for children aged 2 to 5 years.

Consider case history and clinical advice strategies for managing screen time in pediatric patients. Along with proactive evaluation of ocular surface and eyelid health, simple advice like using the 20-20-20 rule can promote healthy habits and may reduce dry eye symptoms, digital eye strain (Talens-Estarelles et al, 2023), and myopia risk (Huang et al, 2015).

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