Are we treating the right dry eye? A comparative analysis of digital eye strain and traditional dry eye disease: a prospective comparative study.

BACKGROUND

The study aimed to compare the clinical features, tear-film characteristics, blinking dynamics, and treatment outcomes of patients with Dry Eye Disease (DED) and Digital Eye Strain (DES), and identify predictors of poor response.

METHODS

This prospective comparative study included 264 participants, with 132 patients in each group (DES and DED). Patients completed the Ocular Surface Disease Index (OSDI) and the Computer Vision Syndrome Questionnaire (CVS-Q). Objective assessments included tear break-up time (TBUT), Schirmer’s test, fluorescein staining, blink rate, and incomplete blink percentage. Treatment outcomes were evaluated after 4 to 6 weeks. Multivariable models were adjusted for age, sex, screen exposure, baseline OSDI, TBUT, MGD, and blink rate.

RESULTS

Mean age was similar in both groups (DES: 39.8 years; DED: 41.7 years; p = 0.222). Median OSDI and CVS-Q scores showed no significant differences. TBUT was longer in DES (6.3 s) vs. DED (5.1 s; p = 0.005), while fluorescein staining was higher in DED (p = 0.027). Schirmer’s test, blink rate, and incomplete blink percentages were comparable. Improvement was seen in 65.2% (DES) vs. 56.1% (DED) (p = 0.291). Predictors of poor treatment response included female sex (OR 1.30; 95% CI 1.05–1.60; p = 0.016), greater daily screen exposure (OR 1.17; 95% CI 1.02–1.35; p = 0.024), higher baseline OSDI (OR 1.020 per point; 95% CI 1.004–1.037; p = 0.013), and shorter TBUT (OR 0.846 per second; 95% CI 0.716–0.999; p = 0.048).

CONCLUSIONS

DES and DED demonstrate overlapping but distinct clinical profiles. TBUT, screen time, age, and symptom severity significantly influence treatment outcomes. Tailored therapeutic approaches that address both tear-film instability and screen-related behaviours are essential for optimal management. Findings should be interpreted in light of differing symptom- versus sign-based group definitions. CLINICAL TRIAL NUMBER: Not applicable.