Relationship between the Use of Video Terminals and Dry Eye Symptoms during the COVID-19 Pandemic: Assessments Based on a Meta-Analytical Approach

Case Report

Austin J Clin Ophthalmol. 2023; 10(1): 1135.

Relationship between the Use of Video Terminals and Dry Eye Symptoms during the COVID-19 Pandemic: Assessments Based on a Meta-Analytical Approach

Perugino A¹, Pellegrini M² and Giannaccare G³*

¹Department of Human Pathology, University of Messina, Italy

²Department of Ophthalmology, University Magna Graecia of Catanzaro, Italy

³Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Italy

*Corresponding author: Giuseppe Giannaccare Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy

Received: November 17, 2022; Accepted: January 03, 2023; Published: January 09, 2023


Purpose: The objective of this meta-analytical study is to consider the impact of the use of VDTs on the onset and/or worsening of the signs and symptoms of dry eye during the COVID-19 pandemic, but also to offer the best solutions to perform the various tasks in daily life in order to safeguard vision, with the aim of promoting a lifestyle that allows you to work and perform different activities more safely and efficiently. Patients should be encouraged to follow proper planning of visits.

Methods: Scientific articles chosen by the following inclusion criteria were analyzed: 1) Type of study (Primary); 2) Population (patients suffering from dry eye); 3) Study period (all studies carried out in the period between January 2020 and January 2022); 4) Result variables (correlation between increased use of VDTs during the pandemic and worsening of the symptoms of dry eye syndrome; correlation between autoimmune mechanism from Covid- 19 and etiology of dry eye); 5) Language (English).

Results: The results of the various cross-sectional studies, obtained thanks to the administration of an online and anonymous questionnaire, have found a correlation between excessive use of VDTs and the onset of complications related to dry eye syndrome. The results suggest that in university students there is a higher incidence of problems related to dry eyes following the many hours spent in front of a screen to follow the lessons that were proposed to them remotely during the lockdown following the COVID-19 pandemic. Dry eye is the most commonly diagnosed pathology among eye disorders during the lockdown, as people spent much more time locked in the house, even 20-24h in the first months of lockdown in 2020.

Conclusions: In conclusion, the analysis of the data shows a correlation between prolonged use of VDTs (exacerbated during the COVID-19 era) and the onset or worsening of dry eye syndrome.

Keywords: Dry eye; Dry eye symptoms; Video terminal; COVID- 19 pandemic

Abbreviations: VDT: Video Terminal; DED: Dry Eye Disease


Dry eye syndrome is a disorder that affects millions of people around the world. In 2017 the TFOS Dry Eye Workshop II (DEWS II) defined dry eye as a multifactorial pathology of the ocular surface, characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which the instability and hyperosmolarity of the tear film, inflammation and damage of the ocular surface, and neurosensory abnormalities play an etiological role. Dry eye is a complex functional disorder that cannot be reduced to a single process, sign or symptom [1].

The earliest symptoms are irritation, burning, foreign body sensation, fluctuations in visual quality, visual fatigue in prolonged reading or prolonged use of Video Terminals (VDT), excessive tearing, sensitivity to light, and discomfort with contact lenses. As dry eye syndrome worsens, symptoms can also degenerate. Over time, patients notice less of the effects of dry eye due to increasing damage to nerve endings, a consequence of chronic dry eye. Previously hyperlacrimant eyes can become totally tear-free. Fluctuation of vision leads to a constant visual reduction, which does not improve even with glasses. The eyes can become permanently roasted with recurrent abrasions, conjunctivitis and eye infections.

The era of technology and communication have completely revolutionized, within a few years, our lives and social relationships. With the spread of smart phones, tablets and computers, screens have become the most observed object during the day. To contribute has been added the pandemic situation, crossed in the last period, which has further meant that the passing of the days is alternated between hours of learning with distance learning and hours of leisure, always remaining with the gaze turned towards digital screens. In fact, the COVID-19 pandemic has affected many countries around the world by imposing a series of restrictive measures such as lockdown (mass quarantines), curfews or similar restrictions (e.g. order to stay at home). All these restrictions were set in order to reduce the spread of COVID-19. These restrictions were applied from early March 2020. During this lockdown period, some solutions have been proposed by experts to improve the manufacturability of remote work and school lessons, including smart working and online school lessons, and precisely these measures have contributed to the increase and abuse of the use of VDT, consequently leading to an increase in dry eye and the worsening of its symptoms. In addition to the classic risk factors that lead to the onset of dry eye syndrome, we can confirm that the period of the COVID-19 pandemic has been decisive in the increase in dry eye pathology in patients all over the world.

Students during the lockdown participated in the lessons in online mode and this showed a high frequency of dry eye symptoms, related to excessive use of VDT. Dry eye could be considered as an emerging health problem widespread mostly in young subjects, probably related to recent lifestyle changes.

It has been shown that people who work long hours with VDTs complain more about eye discomfort.

The main risk factors are summarized as follows:

1. Gender: Women between the ages of 40 and 60 are more affected by dry eye, probably due to the new hormonal balances following menopause.

2. Age: aging is the cause of a progressive atrophy of the lacrimal glands.

3. Climatic-environmental factors: air conditioning, dry climate, cigarette smoke, wind, smog.

4. Use of certain drugs: immunosuppressants, hormones, antihistamines, anti hypertensives, antidepressants and others.

5. Prolonged use of VDT.

6. Nutritional deficits: insufficient intake of vitamin A.

7. Use of contact lenses.

Dry eye, which can give rise to chronic eye disorders and reduce the quality of life, is increasingly induced by environmental pollution and the frequent use of electronic devices [2].

On the one hand, the increase in smart schooling/working exposes to a greater use of VDT, a known risk factor for DED; excessive evaporation of tears is attributable to a prolonged interval of winking during fixation and is thought to be the main causal factor. On the other hand, the extensive use of the mask could represent an additional piece for the complex puzzle of dry eye syndrome during the COVID-19 period. In fact, moving the mask or wearing it incorrectly could disperse the air around the eyes and the infiltrating air could cause a rapid evaporation of tears [3].

Materials and Methods

A protocol has been developed that includes inclusion criteria, research strategy and data analysis. Based on the analysis and robustness of the data, as there were no clinical trials, a systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) [4].

The literature was consulted via the PubMed database. The keywords "dry eye", "dry eye symptoms" combined with "Video terminals" and "COVID-19" were used in literature search. The flowchart showing the literature search and study selection is presented in (Figure 1). Initially, 97 items were identified. After conducting a skimming of the titles and abstracts, 35 articles with full texts were selected. Finally, 13 articles were included as they follow the inclusion criteria established in the research protocol.

Citation: Perugino A, Pellegrini M and Giannaccare G, Relationship between the Use of Video Terminals and Dry Eye Symptoms during the COVID-19 Pandemic: Assessments Based on a Meta-Analytical Approach. Austin J Clin Ophthalmol. 2023; 10(1): 1135.