Lubricating drops produced modest improvements in tear stability and small epithelial changes in patients with prolonged daily screen exposure
A prospective study suggests that preservative-free artificial tears containing carboxymethyl cellulose may improve tear film stability and produce small structural changes in the corneal epithelium among patients with dry eye disease associated with prolonged digital screen use.
Dry eye disease is increasingly recognized among younger populations, partly because extended exposure to digital devices can reduce blink rate and disrupt tear film stability. To evaluate treatment effects in this group, investigators at Himalaya Eye Hospital in Nepal conducted a single-arm interventional study involving 76 patients (120 eyes) aged 20 to 40 years with symptomatic dry eye disease and high daily screen exposure. Patients used preservative-free 0.5% carboxymethyl cellulose artificial tears four times daily for 1 month. Ocular surface parameters were measured prior to and following treatment using Fourier-domain optical coherence tomography and noninvasive tear break-up time (NIBUT) testing.
At baseline, participants reported an average daily screen exposure of 6.3 hours, and clinical testing confirmed reduced tear film stability, with a mean NIBUT of 6.52 seconds. After one month of treatment, researchers observed a statistically significant improvement in tear film stability. Mean NIBUT increased to 7.89 seconds, representing a gain of 1.37 seconds when compared with baseline.
Researchers also detected structural changes in the corneal epithelium. Central corneal epithelial thickness increased from 52.79 μm to 53.65 μm, a mean increase of 0.86 μm. Similar thickening patterns were observed across multiple corneal zones. However, investigators noted that the magnitude of epithelial thickening was small – less than 1 μm – and below the typical repeatability threshold of OCT epithelial mapping. As a result, the clinical significance of these structural changes remains uncertain.
The study also identified a strong relationship between screen use and tear film instability. Baseline analysis showed a significant negative correlation between daily screen time and tear film stability, indicating that higher screen exposure was associated with shorter tear break-up times.
Exploratory analysis suggested that older age within the cohort was associated with greater odds of epithelial thickening after treatment, although the authors cautioned that, because of the number of covariates relative to outcome events, the predictive model may have been underpowered and so requires further validation in larger studies.
The researchers also emphasize that the study’s single-arm design and short follow-up period limit conclusions about causality and long-term benefit. Nonetheless, the findings suggest that lubricating drops may help improve tear film stability in patients with dry eye disease associated with prolonged screen exposure. As screen exposure continues to rise globally, the investigators suggest that early intervention with lubricating therapies may help to mitigate ocular surface dysfunction associated with modern digital lifestyles.
The authors reported no conflicts of interest in this work.
Source: Clinical Optometry
