The short focal lengths and decreased blink rates that stem from digital screen use among children has been a growing concern for quite some time, predisposing kids to both myopia and dry eye. The COVID-19 pandemic certainly hasn’t helped this issue, as lockdowns increased screen use—especially for those who transitioned to remote learning.

Researchers recently investigated the link between devices and dry eye further, in a study of 172 children (age 6-17). They found that children’s excessive electronic screen use is associated with severe meibomian gland atrophy, with 86% of such patients reporting four hours or more of daily electronic screen use and 50% reporting over eight hours. Electronic screen use was positively associated with increased (or worse) meibography scores.

In another finding of the study, 62.5% of severe meibomian gland atrophy cases tested positive for autoimmune biomarker(s), including almost 20% for rheumatoid arthritis, though none had systemic symptoms.

“We hypothesize underlying autoimmune disease biomarker positivity increases the risk of severe meibomian glands in those who also use electronic screens excessively due to a possible additive effect of decreased blink rates,” the authors explained in their study. “Patients with autoimmune diseases, such as Sjögren's syndrome or RA/JIA, can develop immune-mediated damage to the lacrimal and salivary glands resulting in severe dry eye. Similarly, immune-mediated damage to the meibomian glands have been reported in patients with AID.”

The authors suspect early fibrosis and scarring of meibomian gland structures may result in more severe MGA in patients with AID and increased ESU due to decreased blink rates. Children in particular may benefit from preventative measures, such as using warm compresses and blinking exercises to offset low blink rates’ damaging effects on the meibomian glands.

They also added that further research is needed to establish formal electronic screen use limits based on meibography-grade and to evaluate the correlation of autoimmune disease biomarker-positivity in children with severe meibomian gland atrophy.

Cremers SL, Khan A, Ahn J, et al. New Indicator of Children’s Excessive Electronic Screen Use and Factors in Meibomian Gland Atrophy. American Journal of Ophthalmology 2021. Epub ahead of print.