More than 16 million Americans are estimated to have a diagnosis of dry eye disease. And the number of symptomatic patients living without a diagnosis is thought to be almost double. As a health care provider, these patients come through your office every day. You can help them get the care they need before suffering from a significant decrease in their workplace productivity, or an increase in symptoms of anxiety and depression.
Dry eye disease can be difficult to diagnose because it is multifactorial and its symptoms often overlap with digital eye strain. The most common symptoms you may hear in your office are the eyes are stinging, burning, tired, heavy, dry, scratchy, light sensitive, fluctuating vision, contact-lens intolerant, foreign body sensation, and even watering.
This is what is happening in the eyes
While using a digital device, the eyes blink only 7 times a minute compared to 22 times when relaxed. The blinking motion acts to spread tears over the cornea, keeping them healthy and clearing vision. The tear film is a complex mixture of aqueous, mucins, and lipids that form a thin layer on the eye’s surface. The meibomian glands in the eyelids secrete lipids which prevent the tears from evaporating.
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Reduced and incomplete blinking during digital device use destabilizes the tear film and can increase meibomian gland dysfunction. Over years of time, the oil glands atrophy, lipid production slows, vision blurs, and the eyes become red and irritated. This is even more of a problem in our patients with comorbidities like autoimmune disease or androgen deficiency. And, while dry eye disease is multifactorial, digital device overuse is an important, and modifiable, contributing factor.
Three questions to screen for digital device-related dry eye disease
You can find these patients in your own exam rooms by asking a couple of short screening questions:
- Do your eyes sting and burn during sustained screen use?
- Does your vision blur while using a digital device, but clear after blinking your eyes?
- Do you experience persistent, unilateral, painful eyes that are associated with light sensitivity or reduced vision?
Although these questions do not come from a validated dry eye questionnaire, a yes answer to any of these questions should elicit a referral to an eye care provider. And a yes to the last question should result in an urgent referral. If you’d prefer to use a clinically validated screening tool, I recommend the Ocular Surface Disease Index (OSDI-6) consisting of six short questions.
Practical tips clinicians can recommend
You may also want to give your patients a couple of easy tips to reduce their digital eye strain.
Set up your workspace for success
- Adjust the room lighting to reduce glare.
- Place the screen slightly below eye level.
Throughout the day
- Take short breaks to perform a few firm, full blinks.
- Instill preservative-free lubricating drops 1 to 3 times a day.
At the end of the day: Allow yourself to recover from digital device use
- Apply a warm compress to help soften the oils in the meibomian glands.
- Sleep 7 to 9 hours each night.
Consequences of chronic dry eye from digital device use
When patients struggle to keep their vision clear and their eyes comfortable, it is not simply an annoyance that will take care of itself. The 2026 VSP Vision Care Workplace Vision Health Report (a self-reported study) states that 71 percent of desk workers reported screen-related visual discomfort. One in four workers took time off due to this discomfort, averaging 4.5 days off annually.
In a meta-analysis of 22 studies including over 3 million participants, both depression and anxiety scores were found to be higher in patients with dry eye disease. And the 2022 DREAM (Dry Eye Assessment and Management) study found that depression was associated with more severe dry-eye signs and symptoms. The relationship is likely multifactorial and potentially bidirectional.
Conclusion
When patients complain of eyes that sting or burn, watery eyes, or vision that fluctuates while using digital devices, we should neither dismiss the symptoms nor assume the cause will resolve on its own. Utilizing simple screening questions, attention to elevated symptoms, patient counseling, and timely referrals to a trusted eye care provider can differentiate transient visual fatigue from ocular surface disease requiring further evaluation. In a world that places constant demands on vision, taking proactive steps for eye health is a powerful way to stay ahead of potential problems.
Pam Theriot is an optometrist.
