The Impact of Digital Screen Exposure on Dry Eye Disease Among University Students

Dry eye disease (DED) is a growing disorder of the ocular surface that has become a prevalent problem in young adults, mainly because of the increasing use of digital devices for educational and entertainment purposes. University students are especially at risk of DED due to long duration of screen exposure, which has been linked with tear film instability, decreased blink rate and eye discomfort. Aim to assess the effect of digital screen exposure on dry eye disease among students attending the University in Al-Salam Teaching hospital, Mosul city in Iraq. A cross-sectional study was carried out in a hospital setting with 384 undergraduate and post graduate students from the University. The study participants were selected from the Ophthalmology Department of Al-Salam Teaching Hospital by a convenience sampling technique. The study used a structured questionnaire to gather data on the participants' demographic details, digital device usage, lifestyle factors, and the validated Ocular Surface Disease Index (OSDI). All subjects had a full ophthalmic examination, which included Tear Break-Up Time (TBUT), Schirmer I test, slit-lamp biomicroscopy, and fluorescein staining as indicated. Dry eye disease was diagnosed based on the recommendations of the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II). The data were analyzed with the SPSS version 26.0 (IBM Corp., 2019). The Chi-square test and binary logistic regression were used to assess associations p < 0.05 was considered statistically significant. The prevalence of dry eye disease was 45.1% (173/384). The numbers of participants with moderate or severe symptoms were 16.4% and 14.1% respectively. The percentage of children using a smartphone (54.9%) was the highest of the digital devices used and 56.8% of students said that they use a digital screen for more than 6 hours a day. There was a notable correlation between the use of digital devices for more than 8 hours per day with dry eye disease (χ² = 32.64, p < 0.001), with the highest prevalence of 65.2% among students using digital devices for more than 8 hours a day. Multivariable logistic regression identified screen time exceeding eight hours per day (OR = 3.16, 95% CI: 1.92–5.20, p < 0.001), continuous screen use for more than two hours (OR = 2.31, 95% CI: 1.42–3.75, p = 0.001), female sex (OR = 1.62, 95% CI: 1.03–2.55, p = 0.036), and sleep duration of less than six hours per night (OR = 1.88, 95% CI: 1.16–3.03, p = 0.010) as independent predictors of dry eye disease. University students have a high prevalence of DED and there exists a strong association between DED and long-term use of digital screens. Excessive screen time, continuous device use for more than 12 hours a day, female sex and poor sleep quality are significant factors associated with an increased risk of DED. Recommended educational interventions that encourage healthy screen-use habits, regular visual breaks and routine ocular health assessments are recommended to help decrease the burden of dry eye disease in university students.