<?xml version="1.0" encoding="UTF-8"?>
<article article-type="research-article" dtd-version="1.3" xml:lang="en">
  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Czech and Slovak Ophthalmology</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">378</article-id>
      <article-id pub-id-type="doi">10.31348/2025/32</article-id>
      <article-categories>
        <subj-group>
          <subject>Original article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Tear Film Dysfunction and its Association with Smartphone Usage in Adolescents</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Sharma</surname>
            <given-names>Srishti</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6715-2058</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Singh</surname>
            <given-names>Anupam</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2288-1350</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mishra</surname>
            <given-names>Shreya</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0009-0003-1336-2190</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Narang</surname>
            <given-names>Kirti</given-names>
          </name>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Agrawal</surname>
            <given-names>Ajai</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1741-7681</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Kumari</surname>
            <given-names>Ranjeeta</given-names>
          </name>
          <contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5242-2198</contrib-id>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Barun</surname>
            <given-names>Kumar</given-names>
          </name>
        </contrib>
      </contrib-group>
      <pub-date date-type="pub" publication-format="electronic">
        <day>12</day>
        <month>8</month>
        <year>2025</year>
      </pub-date>
      <issue>1</issue>
      <elocation-id>5</elocation-id>
      <abstract>
        <p>Aim: The study aimed to explore the association between duration of smartphone usage and tear film parameters in adolescents through a hospital-based cross-sectional study. Material and methods: A detailed history regarding smartphone usage was obtained, followed by tear film assessment for all the study participants. Tear meniscus height (TMH), Tear film break up time (TBUT), and Schirmer’s I test were done for all participants. Then they were classified into four groups, based on daily smartphone usage: &lt; 2 hours/day, 2–4 hours/day, 4–6 hours/day, and &gt; 6 hours/day. Results: 123 smartphone users of the adolescent age group aged 10–19 years (mean age: 16.6 ±2.8 years) were included. The mean values of tear film parameters were as follows: TMH was 0.25 ±0.1 mm, Schirmer’s I was 17.7 ±9.2 mm, and TBUT was 10.5 ±5.7 seconds. Participants using smartphones for &gt; 6 hours/day had a significantly higher prevalence of reduced TMH (&lt; 0.25 mm) compared to those with lower usage durations (p &lt; 0.0001). Similar trends were observed for Schirmer’s I and TBUT values, indicating a statistically significant association between prolonged smartphone use and tear film dysfunction (p &lt; 0.0001). Notably, 72.7% of eyes in the &gt; 6 hours/day group exhibited tear film dysfunction, significantly higher than in other groups. Conclusion: Prolonged smartphone use adversely affects tear film stability and ocular surface health in adolescents. Awareness and appropriate measures to limit excessive screen time are essential to prevent tear film dysfunction and associated ocular discomfort.</p>
      </abstract>
      <kwd-group>
        <kwd>tear film dysfunction</kwd>
        <kwd>TBUT</kwd>
        <kwd>adolescents</kwd>
        <kwd>smartphone usage.</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <back>
    <ref-list>
      <title>References</title>
      <ref id="R156">
        <mixed-citation>Kim J, Hwang Y, Kang S, et al. Association between exposure to smartphones and ocular health in adolescents. Ophthalmic Epidemiol. 2016;23(4):269-276.</mixed-citation>
      </ref>
      <ref id="R157">
        <mixed-citation>Lissak G. Adverse physiological and psychological effects of screen time on children and adolescents: literature review and case study. Environ Res. 2018;164:149-157.</mixed-citation>
      </ref>
      <ref id="R158">
        <mixed-citation>Lemola S, Perkinson-Gloor N, Brand S, Dewald-Kaufmann JF, Grob A. Adolescents’ electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. J Youth Adolesc. 2015;44(2):405-418. Epub 2014 Sep 10. doi: 10.1007/s10964-014-0176-x.<pub-id pub-id-type="doi">10.1007/s10964-014-0176-x</pub-id></mixed-citation>
      </ref>
      <ref id="R159">
        <mixed-citation>Lua VYQ, Chua TBK, Chia MYH. A narrative review of screen time and wellbeing among adolescents before and during the COVID-19 pandemic: implications for the future. Sports [Internet]. 2023 [cited 2025 Apr 20];11(2):38. Available from: https://www. ncbi.nlm.nih.gov/pmc/articles/PMC9964582/<pub-id pub-id-type="doi">https://www. ncbi.nlm.nih.gov/pmc/articles/PMC9964582/</pub-id></mixed-citation>
      </ref>
      <ref id="R160">
        <mixed-citation>Ichhpujani P, Singh RB, Foulsham W, Thakur S, Lamba AS. Visual implications of digital device usage in school children: a cross-sectional study. BMC Ophthalmol. 2019;19(1):76. doi:10.1186/s12886-019-1082-5<pub-id pub-id-type="doi">10.1186/s12886-019-1082-5</pub-id></mixed-citation>
      </ref>
      <ref id="R161">
        <mixed-citation>Sharma S, Singh A, Agrawal, A, Kumari R. Kumar, B. Association of smartphones use, ocular symptoms and binocular dysfunctions in adolescents: a hospital-based cross-sectional study. Strabismus. 2024;32(4), 279-286. doi: 10.1080/09273972.2024.2382289<pub-id pub-id-type="doi">10.1080/09273972.2024.2382289</pub-id></mixed-citation>
      </ref>
      <ref id="R162">
        <mixed-citation>Allen L, Mehta J. The impact of smartphone use on accommodative functions: pilot study. Strabismus. 2023;31(1):66-72. doi:10.10 80/09273972.2023.2179076</mixed-citation>
      </ref>
      <ref id="R163">
        <mixed-citation>Singh A, Chawla O, Verma R, et al. Video gaming on smartphone and clinical profile of children with strabismus. Natl J Physiol Pharm Pharmacol. 2023. doi:10.5455/njppp.2023.13.06299202322982023<pub-id pub-id-type="doi">10.5455/njppp.2023.13.06299202322982023</pub-id></mixed-citation>
      </ref>
      <ref id="R164">
        <mixed-citation>Shah M, Natarajan SB, Ahmad N. Excessive screen time exposure leads to dry eyes and inflammatory conjunctivitis in children. Ir J Med Sci. 2025. doi:10.1007/s11845-025-03920-9<pub-id pub-id-type="doi">10.1007/s11845-025-03920-9</pub-id></mixed-citation>
      </ref>
      <ref id="R165">
        <mixed-citation>Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283.</mixed-citation>
      </ref>
      <ref id="R166">
        <mixed-citation>Donthineni PR, Kammari P, Shanbhag SS, Singh V, Das AV, Basu S. Incidence, demographics, types and risk factors of dry eye disease in India: electronic medical records driven big data analytics report I. Ocul Surf. 2019;17(2):250-256.</mixed-citation>
      </ref>
      <ref id="R167">
        <mixed-citation>Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case-control study. BMC Ophthalmol. 2016;16(1):188</mixed-citation>
      </ref>
      <ref id="R168">
        <mixed-citation>Chidi-Egboka NC, Jalbert I, Golebiowski B. Smartphone gaming induces dry eye symptoms and reduces blinking in school-aged children. Eye (Lond). 2023;37(7):1342-1349.</mixed-citation>
      </ref>
      <ref id="R169">
        <mixed-citation>Choi JH, Li Y, Kim SH, et al. The influences of smartphone use on the status of the tear film and ocular surface. PLoS One. 2018;13(10):e0206541.</mixed-citation>
      </ref>
      <ref id="R170">
        <mixed-citation>Guo OD, Akpek E. The negative effects of dry eye disease on quality of life and visual function. Turk J Med Sci. 2020;50(SI-2):1611- 1615. doi:10.3906/sag-2002-143<pub-id pub-id-type="doi">10.3906/sag-2002-143</pub-id></mixed-citation>
      </ref>
      <ref id="R171">
        <mixed-citation>Donthineni PR, Das AV, Basu S. Dry eye disease in children and adolescents in India. Ocul Surf. 2020. doi:10.1016/j.jtos.2020.07.019<pub-id pub-id-type="doi">10.1016/j.jtos.2020.07.019</pub-id></mixed-citation>
      </ref>
      <ref id="R172">
        <mixed-citation>Golebiowski B, Long J, Harrison K, Lee A, Chidi-Egboka N, Asper L. Smartphone use and effects on tear film, blinking and binocular vision. Curr Eye Res. 2020;45(4):428-434.</mixed-citation>
      </ref>
      <ref id="R173">
        <mixed-citation>Long J, Cheung R, Duong S, Paynter R, Asper L. Viewing distance and eyestrain symptoms with prolonged viewing of smartphones. Clin Exp Optom. 2017;100(2):133-137.</mixed-citation>
      </ref>
      <ref id="R174">
        <mixed-citation>Khezrzade S, Ehsaei A, Momeni-Moghaddam H, Wolffsohn JS, Oladi Abbas Abadi S. After-effect on tear film quality and quantity of reading on laptop computer screen versus hardcopy. Clin Exp Optom. 2024;107(5):499-503.</mixed-citation>
      </ref>
      <ref id="R175">
        <mixed-citation>Cardona G, García C, Serés C, Vilaseca M, Gispets J. Blink rate, blink amplitude, and tear film integrity during dynamic visual display terminal tasks. Curr Eye Res. 2011;36(3):190-197.</mixed-citation>
      </ref>
      <ref id="R176">
        <mixed-citation>Datta S, Sehgal S, Bhattacharya B, Satgunam PN. The 20/20/20 rule: practicing pattern and associations with asthenopic symptoms. Indian J Ophthalmol. 2023;71(5):2071-2075. doi: 10.4103/ijo.IJO_2056_22<pub-id pub-id-type="doi">10.4103/ijo.IJO_2056_22</pub-id></mixed-citation>
      </ref>
      <ref id="R177">
        <mixed-citation>Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018;3:e000146. doi:10.1136/bmjophth-2018-000146<pub-id pub-id-type="doi">10.1136/bmjophth-2018-000146</pub-id></mixed-citation>
      </ref>
    </ref-list>
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</article>
