Associated Factors of Digital Eye Strain among Clinical Years’ Medical Students and Treatment Results Using Single-Dose Unit Artificial Tears

Main Article Content

Chidkarn Photcharapngsakul


Background: Digital eye strain (DES) is frequently found in university students or individuals using computers or digital devices. Dry eye is one of the most common symptoms. Studies about both conditions among clinical years’ medical students are lacking.
Objective: To determine factors associated with DES in clinical years’ medical students and the treatment results by using single-dose unit artificial tears
Material and method: A cross-sectional and clinical trial study was conducted among the 4th−6th years’ medical students of Lampang Hospital between 20th August and 20th October 2021. DES was diagnosed using the computer vision syndrome questionnaire (CVS-Q) and assessed its severity using the digital eye strain severity score (DESS). Dry eye was evaluated using the ocular surface disease index (OSDI) score and slit-lamp biomicroscopy. All particpants whom diagnosed with DES received single-dose unit artificial tears to apply qid for 1 week and re-evaluated again. Data were compared between groups using Fisher’s exact test and t-test. Factors associated with DES were analyzed using multivariable logistic regression.
Results: Ninety-two medical students were enrolled. The mean age was 22.2 years (SD 1.2) and 49 cases were female. Fifty-three (57.6%) were diagnosed with DES. The most common symptom was dry eye (81.1%). The findings of dry eye were definite in 2, predisposing in 3, and pre-clinical in 22 cases. Factors associated with DES were duration of digital devices use >9 hours/ day (OR 5.58, 95%CI 1.23−25.42, p=0.026), disuse of blue light blocking screen filters (OR 3.14, 95%CI 1.13−8.74, p=0.029) and distance from screen <30 cm (OR 2.97, 95%CI 1.06−8.33, p=0.039). After applying artificial tears, 21 students still had DES. The median DESS score declined from 31 (IQR 19,42) to be 9 (IQR 4,21) (p<0.001).
Conclusion: DES was commonly found in the clinical years’ medical students. Its associated factors were duration of digital devices use >9 hours/ day, disuse of blue light blocking screen filters and distance from screen <30 cm. Single-dose unit artificial tears could reduce its severity.


Download data is not yet available.

Article Details

How to Cite
Photcharapngsakul, C. . (2022). Associated Factors of Digital Eye Strain among Clinical Years’ Medical Students and Treatment Results Using Single-Dose Unit Artificial Tears. Lampang Medical Journal, 42(2), 63–73. Retrieved from
Original Article


The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf.


Portello JK, Rosenfield M, Bababekova Y, Estrada JM, Leon A. Computer-related visual symptoms in office workers. Ophthalmic Physiol Opt.


Sheedy JE, Hayes JN, Engle J. Is all asthenopia the same?. Optom Vis Sci. 2003;80(11):732–9.

Shen Lee B, Kabat AG, Bacharach J, Karpecki P, Luchs J. Managing dry eye disease and facilitating realistic patient expectations: a review and

appraisal of current therapies. Clin Ophthalmol. 2020;14:119–26.

Courtin R, Pereira B, Naughton G, Chamoux A, Chiambaretta F, Lanhers C et al. Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis. BMJ Open. 2016;6(1):e009675.

Reddy SC, Low CK, Lim YP, Low LL Mardina F, Nursaleha MP. Computer vision syndrome: a study of knowledge and practices in university students. Nepal J Ophthalmol. 2013;5(2):161–8.

Salibello C, Nilsen E. Is there a typical VDT patient? A Dermographic analysis. J Am Optom Assoc. 1995;66(8):479–83.

Rossignol AM, Morse EP, Summers VM, Pagnotto LD. Video display terminal use and reported health symptoms among Massachusetts clerical workers. J Occup Med. 1987;29(2):112–8.

Chawla U, Yadav P, Chugh JP, Chadha G. Study of digital eye strain due to extended digital devics use among undergraduate medical students during the COVID-19 pandemic: a cross sectional study. International Journal of All Research Education and Scientific Methods (IJARESM). 2021;9:991–8.

Logaraj M, Madhupriya V, Hedge Sk. Computer vision syndrome and associated factors among medical and engineering students in Chennai. Ann Med Health Sci Res. 2014;4(2):179–85.

Iqbal M, Elzembely H, Elmassry A, Elghaeieb M, Assaf A, lbrahim O, et al. Computer vision syndrome prevalence and ocular sequelae among medical students: a university-wide study on a marginalized visual security issue. The Open Ophtahlmology Journal. 2021;15:156–70.

Abudawood GA, Ashi HM, Almarzouki NK. Computer vision syndrome among undergraduate medical students in King Abdulaziz University, Jeddah, Saudi Arabia. Hindawi Journal of Ophthalmology. 2020:2789376.

Khan AA, Jain R, Hegde V, Bappal A, Rashmi S. Digital eye strain among undergraduate medical student in a tertiary eye care hospital of south India – a questionnaire based study. India Journal of Clinical and Experimental Ophthalmology. 2019;5(2):208–10.

Segui MdM, Cabrero-García J, Crespo A, Verdu J. Reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol. 2015;68(6):662–73.

Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Arch phthalmol.


Ganne P, Najeeb S, Chaitanya G, Sharma A, Krishnappa NC. Digital eye strain epidermic amid COVID-19 pandemic – a cross-sectional survey. Ophthalmic Epidemiol 2021;28(4):285–92.

Noreen K, Batool Z, Fatima T, Zamir T. Prevalence of computer vision syndrome and its associated risk factors among under graduate medical students. Pak J Ophthalmol. 2016;32(3)140–6.

Reddy SC, Low CK, Lim YP, Low LL, Mardina F, Nursaleha MP. Computer vision syndrome: a study of knowledge and practices in university students. Nepal J Ophthalmol. 2013;5(2):161–8.

Rafeeq U, Omear M, Chauhan L, Maan V, Agarwal P. Computer vision syndrome among individuals using visual display terminals for more than two hours. Delta Journal of Ophthalmology. 2020;21(3):139–45.

Agarwal S, Goel D, Sharma A. Evaluation of the factors which contribute to the ocular complaints in computer users. J Clin Diagn Res. 2013;7(2):331–5.

Zayed HAM, Saied SM, Younis EA, Atlam SA. Digital eye strain: prevalence and associated factors among information technology professionals, Egypt. Environ Sci Pollu Res Int. 2021;28(20):25187–95.

Ranasinghe P, Wathurapatha WS, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N,et al. Computer vision syndrome among computer office workers in a developing country: an evaluation of prevalence and risk factors. BMC Res Notes. 2016;9:150.

Rosenfield M, Li RT, Kirsch NT. A double-blind test of blue-blocking filters on symptoms of digital eye strain. Work. 2020;65(2):343–34.

Shantakumari N, Eldeeb R, Sreedharan J, Gopal K. Computer use and vision-related problems among university students in ajman, United arab emirate. Ann Med Health Sci Res. 2014;4(2):258–63.

Palavets T, Rosenfield M. Blue blocking filters and digital eye strain. Optom Vis Sci. 2019;96(1):48–54.

Toomingas A, Hagberg M, Heiden M, Richter H, Westergren KE, Tornqvist EW. Risk factors, incidence and persistence of symptoms from

the eyes among professional computer users. Work. 2014;47(3):291–301.

Mowatt L, Gordon C, Santosh ABR, Jones T. Computer vision syndrome and ergonomic practices among undergraduate university

students. Int J clin Pract. 2017;10:e13035.

Acosta MC, Gallar J, Belmonte C. The influence of eye solutions on blinking and ocular comfort at rest and during work at video display terminals. Exp Eye Res. 1999;68(6):663–9.

Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt. 2011;31(5):502–15.

Tsubota K, Nakamori K. Dry eyes and video display terminals. N Engl J Med. 1993;328(8):584.

Schlote T, Kadner G, Freudenthaler N. Marked reduction and distinct patterns of eye blinking in patients with moderately dry eyes during video display terminal use. Graefes Arch Clin Exp Ophthalmol. 2004;242(4):306–12.

Himebaugh NL, Begley CG, Bradley A, Wilkinson JA. Blinking and tear break-up during four visual tasks. Optom Vis Sci. 2009;86(2):106–14.

Uchino M, Yokoi N, Uchino Y, Dogru M, Kawashima M, Komuro A, et al. Prevalence of dry eye disease and its risk factors in visual display terminal users: the Osaka study. Am J Ophthalmol. 2013;156(4):759–66.

Mehra D, Galor A. Digital screen use and dry eye: a review. Asia Pac J Ophthalmol (Phila).