A new childhood epidemic: Excessive screen time's link to eye and vision issues

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published January 25, 2024

Key Takeaways

  • Digital eye strain results from prolonged use of digital devices, with symptoms including dry, red, and itchy eyes, as well as eye strain, photophobia, and strabismus. 

  • The pandemic-driven increase in screen time for children has led to a significant rise in the incidence of digital eye strain, affecting 50% to 60% of children.

  • Smaller screens and glare contribute to eye strain, with a potential for early onset refractory errors.

In the past, children who did not constantly use digital devices did not have a noteworthy incidence of early onset refractory errors. However, the duration of screen usage has surged across all age groups worldwide, extending even to preschoolers—a trend accentuated by the COVID-19 pandemic. 

Digital Eye Strain (DES) or Computer Vision Syndrome has become an escalating concern globally, particularly among children. The American Optometric Association states that DES is “a group of eye- and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use.”[]

An epidemic within a pandemic

The limitations on outdoor engagements and the shift toward home-based education contributed to a notable uptick in the utilization of digital devices by children.

According to a 2023 study, kids aged 4-12 spent an average of 4 hours daily on recreational screens before the pandemic. In the initial pandemic phase, this time increased by 0.89 hours per day, and in the subsequent phase, it rose by 0.70 hours per day.[] Consequently, the prevalence of DES among children during these constraints escalated to approximately 50% to 60%.[]

Kids are hooked on screens

Today, children are experiencing higher risks of eye issues due to screen time, especially if they have a genetic predisposition for parental myopia.

Public health experts also worry about how excessive screen time causes sedentary behavior in kids, affecting their physical and mental health. Children and teens growing up in the digital age, spend a significant amount of time on screens to play, learn, and even socialize, which could inevitably impact their developing brains and bodies.[] 

But when it comes to DES and other eye and vision issues, the problem lies in the decreasing size of screens, seen in devices like mobile phones and tablets, which reduces working distance and forces the eyes to exert extra effort for focus, leading to eye strain.

Additionally, screens emit glare from backlighting, which is absent in printed materials, further intensifying eye strain. 

Negative health effects of too much screen time

Dry eyes

The symptoms of DES are closely linked to those of dry eye syndrome. The reduced blink rate, common during prolonged screen usage, disrupts the tear film. Research indicates a significant drop in blink rate from 22 blinks per minute to 7 blinks per minute when using an electronic screen continuously.[] 

Sudden onset of vision errors

Excessive near-sighted work and prolonged screen time are linked with acute acquired concomitant esotropia (AACE) in children as young as 4 years old. AACE is a relatively rare form of strabismus marked by sudden onset of esotropia and diplopia.[]

Other common symptoms of DES in children, as reported in a Preventive Medicine review, include:[]

  • Tired-looking, inflamed, red, and itchy eyes

  • Foreign body sensation in the eyes

  • Eye irritation with frequent rubbing of eyelids

  • Excessive tearing or water in the eyes

  • Blurring of vision

  • Appearance of colored halos around objects

  • Photophobia 

  • Frequent headaches

Persistent vision issues

While most symptoms typically improve with reduced digital screen usage, some can endure, becoming permanent or persistent.

For instance, the American Optometric Association notes that blurred distance vision may persist even after screen time ends. Additionally, prolonged squinting due to glare sensitivity from bright digital screens can lead to eye strain, hinder reading speed, and contribute to short-sightedness, forming lasting vision abnormalities.

Failure to address the root cause may result in these symptoms returning and worsening with future screen use.

Aggravating factors

Pre-existing farsightedness, astigmatism, poor eye focusing, coordination issues, and age-related changes such as presbyopia can also contribute to visual symptoms of DES when using digital screens. 

The systematic review published in Preventive Medicine, which was commissioned by the World Society of Pediatric Ophthalmology and Strabismus, evaluated factors aggravating or alleviating DES symptoms in pre-presbyopic subjects using digital screens.

Overall, data from 1,171 children and 1,194 adults was assessed. The report found a positive association between neck pain, poor ergonomic parameters at work, and extended daily duration of digital device use with DES. Conversely, interventions such as blue filter lenses and adherence to the 20-20-20 rule showed no significant alleviating effects.

Prevention and management of DES

Despite attempts by academic societies to offer guidelines, establishing clear duration recommendations for screen use in minors remains a challenge. To promote healthier digital device use among children, consider the following tips:

  • Educate children, parents, and teachers about preventive measures, particularly for children at a higher risk of myopia, such as those with a family history of myopia or a lower hyperopic error compared to age-related norms, and those attending schools with excessive academic pressure.

  • Encourage parents to instruct their children to take conscious breaks from screen time at home and school to support proper eye development. One effective strategy is the 20-20-20 rule, which suggests taking a break every 20 minutes looking at something at least 20 feet away for a duration of 20 seconds.

  • Emphasize the importance of maintaining an optimal distance from books and screens. Advise individuals to keep an elbow-to-hand distance to prevent the screen from being too close to the eyes.

  • Advise parents to limit their children’s recreational screen time, excluding school-related activities, to a maximum of 2 hours per day for school-aged children.

What this means for you

Addressing children's eye health is a public health priority. Physicians can consider a comprehensive approach while not exclusively focusing on limiting screen time, as the negative effects of screen time extend beyond eyes. Individuals should prioritize a balance between screen time and outdoor activities to promote the well-being of the younger generation.

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