Computer Use Linked to Dry Eye, Change in Tears

Veronica Hackethal, MD

June 11, 2014

Using a computer for long hours is linked to dry eye disease and decreased concentrations of Mucin5AC (MUC5AC) in tears, according to a study conducted among Japanese office workers and published online June 5 in JAMA Ophthalmology.

This is the first study to link MUC5AC, which belongs to a group of protective substances in tears called mucins, with dry eye disease and computer use. Dry eye disease has been associated with impairment in performing daily activities, as well as decreased productivity at work. Past studies have linked frequent computer use to dry eye disease and suggested an association between the dry eye symptoms of Sjögren's syndrome and decreased concentrations of MUC5AC.

"Our data mean that secreted mucin (MUC5AC), which is a lubricant in human tears, is decreased in people using computers. Furthermore, our data show that the eye strain group had significantly lower concentrations of MUC5AC in tears," first author Yuichi Uchino, MD, PhD, an assistant professor at Keio University School of Medicine in Tokyo, Japan, told Medscape Medical News.

"When ophthalmologists see dry eye patients with substantial eye strain, they should assess whether MUC5AC concentrations are decreased in tears in these patients," Dr. Uchino advised, mentioning 2 medications that induce MUC5AC secretion from goblet cells in the conjunctiva: diquafosol tetrasodium (3% Diquas ophthalmic solution, Santen Pharmaceuticals), available in Japan and South Korea, and rebamipide (Mucosta ophthalmic suspension UD2%, Otsuka Pharmaceutical), available in Japan only.

Called the Osaka Study, the current study included 96 volunteers (60 men, 36 women) employed as Japanese office workers, who completed questionnaires about their dry eye symptoms and daily computer use, which they categorized as short (<5 hours), intermediate (5 - 7 hours), and long (>7 hours). Researchers conducted clinical exams and diagnosed dry eye disease as definitely present, probable, or not present. They also analyzed tear fluid from both eyes for concentration of MUC5AC.

Participants had a mean age of 41.7 years and a median duration of computer use of 8.2 hours per day. Nine percent (n = 9) had definite dry eye disease, whereas 57% (n = 55) had probable dry eye disease. Computer users with definite dry eye disease had lower mean MUC5AC concentrations compared with those without dry eye disease (3.5 ng/mg vs 8.2 ng/mg, respectively; P = .02).

Likewise, those with longer computer use had lower mean MUC5AC concentrations than those with shorter computer use (>7 hours: 5.9 ng/mg vs <5 hours: 9.6 ng/mg, respectively; P = .049). Those with symptomatic eye strain also had lower mean MU5AC concentrations compared with those without symptoms of eye strain (5.1 ng/mg vs 8.2; P = .001).

The authors note, however, that the definite dry eye disease group (n = 9) was much smaller than the probable dry eye disease (n = 55) and no dry eye disease (n = 32) groups, which could have introduced sample bias into the results.

"The link between computer use and dry eye disease is probably not coincidental, since people who use these devices blink at a rate that is one-third less than normal, and we know that blinking and lubricating of the surface is important to prevent dryness," Mina Massaro-Giordano, MD, associate professor of clinical ophthalmology at the University of Pennsylvania School of Medicine and codirector of the Penn Dry Eye and Ocular Surface Center, Philadelphia, told Medscape Medical News when contacted for an outside opinion. "Patients who use these devices have more symptoms, and if they have an underlying surface disease issue, it can be exacerbated with computer use."

Dr. Massaro-Giordano mentioned, however, that a decrease in MUC5AC may be only 1 reason why people who use computers develop dry eye symptoms. The tear film is made of a complex mix of fluid, mucous, and oil. MUC5AC is considered a gel-forming mucin, and Dr. Massaro-Giordano explained that alterations in other types of secretory mucins, such as soluble, surface, or transmembrane mucins, may also be linked to dry eye symptoms. Other causes of surface dryness could include tear insufficiency, evaporative dry eye problems, changes in the amount of oil released from glands in the lids, decreased blink rate, contact lens wear, hormones, environmental causes, and medications.

"When computer use is part of the problem, ophthalmologists should address and treat the problems of dry eye," Dr. Massaro-Giordano urged, "Ophthalmologists should do a refraction test to make sure the patient is wearing the appropriate prescription and the right type of glasses and [should] discuss the ergonomics of computer use, including screen height, chair position, and glare protection."

This study was sponsored by a Grant-in-Aid for Young Scientists from the Ministry of Health, Labour and Welfare and the Ministry of Education, Science, Sports, and Culture, and Santen Pharmaceutical Co, Ltd. Two coauthors report being consultants to and 2 coauthors are employees of Santen Pharmaceutical Co, Ltd. The other authors and Dr. Massaro-Giordano have disclosed no relevant financial relationships.

JAMA Opthalmol. Published online June 5, 2014. Abstract

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