Tear Film Dynamics in Visual Display Terminal Users: A Review of Impact on Goblet Cells, Lacrimal and Meibomian Gland Function

PurposeThe prevalence of dry eye disease (DED) is rising among visual display terminal (VDT) users, a trend that correlates with the growing use of digital devices. The prevalence of VDT-associated DED is reported based on dry eye questionnaires; however, VDT's impact on tear film parameters is less understood.MethodsA review of published literature on both the alterations in tear film observed in VDT users and the impact of various interventions on their tear film.ResultsMost studies show reduction in tear stability as well as reduction in the blink rate. The role of lacrimal gland hypofunction in visual display terminal (VDT) users is a subject of ongoing debate. Schirmer test values typically exceed the 10 mm threshold, suggesting normal tear production, and tear osmolarity remains within normal ranges but VDT users consistently present with lower Schirmer values compared to non-VDT users. The effects on Meibomian glands and mucin levels need more research as the numbers studied are small. Very few studies have analysed mucin levels in VDT users with reports of normal or reduced values. Even asymptomatic users can have tear film instability; hence, the diagnostic criteria need to be formulated and validated. Different interventions such as neurostimulation, blink improving apps, eyelid warming devices, moist goggles, and lubricants have been explored in VDT users but without a control arm and in asymptomatic VDT users in most studies.ConclusionThe alterations have been observed on aqueous, lipid and mucin components of the tear film, although the extent of the impact is variable across studies. There is urgent need of well-designed studies for studying the tear film changes and management options for the upcoming lifestyle epidemic in VDT users.