Dry Eye Disease (DED) is one of the most common ocular surface disorders encountered in ophthalmic practice. The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop II defines DED as a multifactorial disease characterized by loss of tear film homeostasis, accompanied by ocular symptoms in which tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play etiological roles (1). DED significantly affects quality of life, visual function, work productivity, and psychosocial well-being.

The global prevalence of DED varies widely, ranging from approximately 5% to 50%, depending on diagnostic criteria, geographic location, and study population (2). Increasing urbanization and widespread use of digital devices have contributed to the rising incidence of DED worldwide. The advent of smartphones, laptops, tablets, and desktop computers has dramatically altered visual habits across all age groups.

Digital screen use has been identified as a major risk factor for DED. During prolonged screen viewing, blink rate decreases significantly, leading to increased tear evaporation and tear film instability (3). Incomplete blinking further contributes to meibomian gland dysfunction and ocular surface stress. Studies have demonstrated that individuals using digital devices for extended durations experience symptoms such as dryness, burning sensation, foreign body sensation, itching, photophobia, and blurred vision (4).

The COVID-19 pandemic accelerated dependence on digital devices due to online education, remote work, and virtual communication. Consequently, reports of digital eye strain and DED increased substantially among students and working professionals (5). Environmental factors such as air conditioning, low humidity, prolonged indoor stay, and poor ergonomics may exacerbate symptoms.

Several risk factors have been associated with DED, including female gender, advancing age, contact lens wear, systemic diseases, autoimmune disorders, smoking, and certain medications (6). However, screen-related factors such as duration of use, viewing distance, frequency of breaks, and device type have gained increasing attention in recent years.

Early identification of DED among digital device users is essential because chronic ocular surface damage may impair visual performance and quality of life. Despite increasing digitalization, limited data are available regarding the prevalence and risk factors of DED among digital device users in many tertiary care settings.

Therefore, the present study was undertaken to determine the prevalence of Dry Eye Disease among digital device users attending a tertiary care hospital and to identify factors associated with its occurrence.

This is a Hospital-based cross-sectional observational study was conducted in the Department of Ophthalmology, Tertiary Care Teaching Hospital over a period of 6 months. Adult digital device users attending the Ophthalmology Outpatient Department. Inclusion Criteria 1. Age ≥18 years. 2. Use of digital devices (smartphone, tablet, laptop, desktop) for at least 2 hours/day. 3. Willingness to provide informed consent. Exclusion Criteria 1. Active ocular infection. 2. Recent ocular surgery (<6 months). 3. Severe ocular trauma. 4. Known Sjögren syndrome. 5. Patients receiving topical medications affecting tear secretion. Sample Size Sample size was calculated using the formula: n = Z²PQ/d² where: • Z = 1.96 • P = expected prevalence • Q = 100 − P • d = allowable error The final sample size was calculated as ___ participants. Data Collection Participants were interviewed using a structured questionnaire collecting information on: • Age • Gender • Occupation • Duration of digital device use • Type of device used • Contact lens use • Smoking history • Air-conditioned workplace exposure • Systemic illnesses Ocular Examination Ocular Surface Disease Index (OSDI): The OSDI questionnaire was administered to assess symptom severity. Tear Break-Up Time (TBUT): Fluorescein dye was instilled and tear film stability measured under slit lamp examination. TBUT <10 seconds was considered abnormal. Schirmer's Test: Standard Schirmer strips were used without anesthesia. Wetting <10 mm in 5 minutes was considered suggestive of dry eye. Slit Lamp Examination Assessment included: • Tear meniscus height • Corneal staining • Conjunctival changes • Meibomian gland status Diagnostic Criteria: DED was diagnosed based on symptoms and at least one abnormal clinical test. Statistical Analysis Data were entered into Microsoft Excel and analyzed using SPSS version ___. Continuous variables were expressed as mean ± SD and categorical variables as frequencies and percentages. Chi-square test and logistic regression analysis were used to determine associations. A p-value <0.05 was considered statistically significant. Ethical Considerations Institutional Ethics Committee approval was obtained. Written informed consent was secured from all participants before enrollment.

Table 1. Demographic Characteristics of Participants (n = 300)

Most participants were aged 18–30 years (37.3%). Females constituted 54.0% of the study population.

Table 2. Prevalence of Dry Eye Disease

The prevalence of Dry Eye Disease among digital device users was 42.0%.

Table 3. Association Between Screen Time and Dry Eye Disease

Participants using digital devices for more than 6 hours daily had the highest prevalence of DED (60.0%), demonstrating a statistically significant association between screen time and DED (p < 0.001).

Table 4. Risk Factors Associated with Dry Eye Disease (Multivariate Logistic Regression)

Screen time exceeding 6 hours/day was the strongest predictor of DED (OR = 3.47). Female gender, contact lens use, and air-conditioning exposure were also significantly associated with DED, whereas smoking was not statistically significant.

Table 5. Clinical Test Findings Among Participants

Abnormal TBUT was observed in 41.3% of participants and represented the most common objective finding suggestive of tear film instability.

Table 6. Severity of Dry Eye Disease Based on OSDI Score

Moderate-to-severe symptoms were observed in 26.7% of participants, indicating a substantial symptomatic burden among digital device users.

The present study evaluated the prevalence of Dry Eye Disease among digital device users attending a tertiary care hospital and explored associated risk factors. DED is increasingly recognized as a public health concern due to the rapid expansion of digital technology and prolonged screen exposure. The prevalence observed in the present study is comparable to findings reported by Stapleton et al., who highlighted the growing burden of DED worldwide (2). Variations in prevalence across studies may be attributed to differences in diagnostic criteria, environmental conditions, and population characteristics. A significant association was observed between prolonged digital device use and DED. Continuous screen viewing reduces spontaneous blink rate and increases tear evaporation, resulting in ocular surface instability (3). Rosenfield reported that digital eye strain and dry eye symptoms are common among individuals engaged in prolonged computer use (4). Female participants demonstrated a higher prevalence of DED. Similar findings have been reported in previous epidemiological studies, suggesting hormonal influences on tear film physiology and meibomian gland function (6). Estrogen-related changes may contribute to ocular surface vulnerability. Participants exposed to air-conditioned environments also showed increased risk of DED. Reduced ambient humidity accelerates tear film evaporation and worsens symptoms. Environmental modification has therefore been recommended as an important preventive strategy (7). Contact lens use emerged as another important risk factor. Contact lenses can disrupt tear film stability and increase ocular surface friction, leading to symptomatic dryness (8). Proper lens hygiene and regular ophthalmic evaluation are therefore essential. The study findings underscore the importance of behavioral interventions. Adoption of the 20-20-20 rule, optimization of screen position, frequent blinking, and periodic breaks can help reduce symptom severity. Artificial tears and environmental modifications may provide additional benefit. A major strength of the study is the comprehensive evaluation using both symptom-based and objective diagnostic tests. However, being a hospital-based cross-sectional study, causal relationships cannot be established. Self-reported screen time may also introduce recall bias. Future multicentric studies involving larger populations and longitudinal follow-up are recommended to better understand the long-term effects of digital device use on ocular surface health.

Dry Eye Disease is a common ocular disorder among digital device users attending tertiary care hospitals. Prolonged screen exposure, female gender, contact lens use, and air-conditioned environments are important risk factors. Routine screening and preventive measures should be incorporated into ophthalmic practice to reduce disease burden and improve quality of life.

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