Screen Use and Meibomian Gland Atrophy in Children
American Journal of Ophthalmology, September 2021
During the COVID-19 pandemic, children increased their use of electronic screens for schoolwork as well as for social and recreational purposes. Prolonged screen use is known to decrease blink rates and exacerbate the risk of dry eye disease in adults; Cremers et al. studied its effects on meibomian glands in children. They also explored autoimmune disease biomarker positivity as a possible independent risk factor for severe meibomian gland atrophy. Their findings suggest that excessive screen use is linked to severe gland atrophy in children and that an underlying autoimmune disease may exacerbate this effect.
For this retrospective cross-sectional study, the researchers included children 6 to 17 years of age whose meibomian gland atrophy grade was 2 or higher for at least one eyelid according to meibography. Age-matched controls had gland atrophy grades of 1 or less. Questionnaires were used to obtain information on dry eye symptoms, daily habits regarding use of electronic screens, diet, and time spent outdoors. Those with severe gland atrophy were assessed for autoimmune disease biomarkers if a positive rheumatoid factor was identified.
Forty-one children met the inclusion criteria (mean age, 11 years). Seventeen of them had severe gland atrophy (grade >2); the other 24 constituted the control group. All patients with severe atrophy had ocular signs or symptoms of dry eye disease, including corneal neovascularization (43%) and decline of best-corrected visual acuity (41%). Control patients had no clinically meaningful dry eye symptoms or signs. Among patients with severe atrophy, 86% reported 4 or more hours of cumulative screen use per day, and 50% reported 8 or more hours. No control participants used electronic screens more than 2 hours a day.
Patients with severe meibomian gland atrophy had significantly higher meibography scores, and cumulative screen use time correlated with increased meibography scores in adjusted and unadjusted analyses (odds ratios, 2.74 and 2.81, respectively). Among the 16 patients with severe gland atrophy who were tested for autoimmune bio-markers, 10 had a positive result, although they had no systemic symptoms.
The authors encourage more research to establish limits on the use of electronic screens based on meibography grade and to further explore the relationship between biomarkers of autoimmune diseases and meibomian gland atrophy. In the interim, they advise limiting screen use for children who have severe atrophy or relevant autoimmune diseases.
The original article can be found here.