Digital Dry Eye Dilemma

Why Your Regular Pharmacy Eye Drops May Not Be the Best Choice for Screen Use Related i.e. Digital Dry Eye

If your eyes feel dry, tired, gritty, or blurry, you may reach for lubricating eye drops. This often happens after long computer use and can be a symptom of digital dry eye.

That seems logical.... Dry eyes need more moisture... so add moisture.  But this is an endless, generally unproductive treatment.

When we concentrate on a computer, tablet or smartphone, our blinking changes. We may blink less often and, importantly, we tend to make more incomplete blinks. That means the upper and lower eyelids do not completely meet and redistribute the tear film properly across the eye.[1–3]

The tear film can become unstable between blinks. This exposes the ocular surface to greater drying and desiccation stress.

For us that spend hours every day looking at screens, the better question may be:

“How do I help my tears remain stable and protect my eyes while they are being exposed to prolonged drying?”

That is an important difference that just adding more lubricant.

Your tear film is not just water

It is easy to imagine tears as little more than salty water.

They are not.

The tear film is a sophisticated environment that must remain sufficiently stable across the surface of the eye between blinks. When that tear film becomes unstable, areas of the ocular surface can begin drying before the next complete blink occurs.

Normally, blinking continually redistributes the tear film.

But imagine sitting in front of a computer and concentrating intensely on an email, spreadsheet, report or video.

You stare.

Your blinking changes.

Some blinks may be incomplete.

The interval during which portions of your ocular surface are exposed can increase.

This is one of the reasons prolonged digital-device use is associated with dry-eye symptoms and tear-film abnormalities.[1–3]

This is where the choice of eye drop becomes important.

Many traditional lubricating drops primarily add moisture

There is nothing inherently wrong with a conventional artificial tear.

A basic lubricating drop can be an excellent product for the right - typically older - patient.

But different artificial tears use different ingredients and are designed to accomplish somewhat different things.

Is your dry eye from prolonged screen use? Adding liquid may give temporary relief. It doesn't fully address tear-film instability. It also ignores drying stress between blinks. This is Digital Dry Eye!

Think about it this way:

If you have a container that is continually losing water, you could keep pouring more water into it.

Or you could ask why the water is being lost so quickly in the first place.

Screen-related dry eye often requires us to think about both sides of that equation.

This is why Thealoz Duo and other Anti-evaporation drops are so interesting for heavy screen users - Digital Dry Eye

Thealoz Duo is quite different from many traditional lubricating eye drops because it combines two ingredients with complementary functions:

3% trehalose + 0.15% sodium hyaluronate.

Sodium hyaluronate — a form of hyaluronic acid — is an excellent water-binding lubricant. It helps hydrate the ocular surface and improve lubrication and tear-film stability.[4]

But the ingredient that makes Thealoz Duo, I-Drop MGD and LABtriactiv all particularly interesting is trehalose.

What exactly is trehalose?

Trehalose is a naturally occurring disaccharide — a type of sugar — with some unusual biological properties.

In nature, trehalose helps organisms withstand dehydration and environmental stress. This applies to certain cells as well.

On the ocular surface, research has demonstrated protective effects of trehalose against desiccation-related cellular damage.[5]

That distinction is important.

Trehalose isn't simply another ingredient added to make the eye feel wetter.

It has bioprotective and osmoprotective properties. These help ocular-surface cells tolerate stressful dry eye environments. [5,6]

And that is highly relevant when you spend hours looking at a screen and have digital dry eye.

Screen dry eye creates a desiccation problem

Tears evaporate and the tear film becomes unstable. The remaining tear film gets concentrated. This is called tear hyperosmolarity.

Hyperosmolarity is now recognized as an important part of the dry-eye disease cycle.[7] - Especially Digital Dry Eye

Trehalose is interesting. It protects epithelial cells against desiccation and osmotic stress. [5,6]

Thealoz Duo isn't just a stronger lubricant. It addresses two different requirements simultaneously. This makes more sense.

Hyaluronic acid helps provide and retain hydration. Trehalose helps protect the ocular surface from the stress created when the tear environment becomes dry and hyperosmotic.

That is fundamentally different from simply putting another dose of watery lubricant onto the eye.

Does trehalose actually stop digital dry eye and tears from evaporating?

This deserves an important clarification.

I often call products like Thealoz Duo part of an anti-evaporative dry-eye strategy. This is especially for heavy computer users.

Trehalose does not create an oily barrier over tears. A lipid-containing artificial tear supplements the outer lipid layer. Trehalose works differently.

Thealoz Duo does not contain a lipid ingredient.

Its advantage is different.

Trehalose protects the ocular surface from desiccation and osmotic stress. Sodium hyaluronate retains water and lubricates the eye. It also stabilizes the tear film. [4–6]

Studies of trehalose/hyaluronate show improved dry-eye symptoms and clinical signs. Randomized studies reported advantages. This was over some hyaluronate-only formulations. [8–10]

It is well-suited for drying environments from prolonged screen use. Its mechanism is not a lipid-replacement eye drop. 

The goal should be tear-film stability — not just temporary wetness for digital dry eye treatment

This is perhaps the biggest mistake people make when shopping for eye drops.  Many folks judge a product by what happens in the first 30 seconds.

“My eyes feel wetter”

This tells us about lubrication. It doesn't show how well it supports the ocular surface. This applies to several hours of computer use.

A better digital dry eye strategy considers:

     How stable is the tear film between blinks?

     How well hydrated is the ocular surface?

     How much desiccation stress is occurring?

    Is there a complete blink?

     Is there an underlying ocular health issue?

That is why one eye drop cannot possibly be the ideal choice for every dry-eye patient.

For heavy computer users and digital dry eye sufferers, use your drops proactively

There is another important difference in how I recommend eye drops for digital-device users.

Don't necessarily wait until your eyes are uncomfortable.

Are you spending four, six, or eight hours on a computer? Use an appropriate dry-eye drop. Do this before irritation becomes significant.

Support the tear film and ocular surface during the activity. Don't just rescue irritated eyes after work. Address the problem directly.

The same principle applies to blinking.

Occasionally looking away from your screen and consciously performing several slow, complete blinks can help redistribute the tear film. Simply blinking more rapidly is not necessarily the objective — complete blinking matters.

So should you throw away your pharmacy eye drops?

Absolutely not.

There are many excellent artificial tears available through pharmacies, optometry offices and specialty retailers.

The issue isn't pharmacy eye drops versus professional eye drops.

You can see our selected Digital Device Eye Drops here.

These products have been selected specifically with the demands of prolonged digital dry eye use in mind.

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One final point: persistent “screen dry eye” may not simply be screen dry eye

Burning, fluctuating vision, grittiness and tired eyes can have many causes.

Many factors contribute to dry eyes. These include meibomian gland dysfunction and blepharitis. Aqueous-deficient dry eye is another factor. Ocular allergy, contact lenses, and medications also contribute. Environmental humidity and uncorrected vision problems are relevant.

Do you apply artificial tears continuously without relief? It may be time for a dry-eye assessment. Don't just try another bottle.

The best eye drop for digital dry eye isn't necessarily the one that adds the most moisture. It is the one that best targets why your eyes are becoming dry in the first place.  

References

1. Argilés M, Cardona G, Pérez-Cabré E, Rodríguez M. Blink Rate and Incomplete Blinks in Six Different Controlled Hard-Copy and Electronic Reading Conditions.Investigative Ophthalmology & Visual Science. 2015.
2. Portello JK, Rosenfield M, Chu CA. Blink Rate, Incomplete Blinks and Computer Vision Syndrome.Optometry and Vision Science. 2013.
3. Talens-Estarelles C, et al. Use of Digital Displays and Ocular Surface Alterations: A Review.The Ocular Surface. 2021.
4. Srinivasan S, et al. Safe and Effective Management of Dry Eye Symptoms with Artificial Tears containing Hyaluronic Acid. 2023.
5. Chen W, et al. Trehalose Protects Against Ocular Surface Disorders in Experimental Murine Dry Eye Through Suppression of Apoptosis.Experimental Eye Research. 2009.
6. Luyckx J, Baudouin C. Trehalose: An Intriguing Disaccharide with Potential for Medical Application in Ophthalmology.Clinical Ophthalmology. 2011.
7. Baudouin C, et al. Role of Hyperosmolarity in the Pathogenesis and Management of Dry Eye Disease. 2013.
8. Pinto-Bonilla JC, et al. A Randomized Crossover Study Comparing Trehalose/Hyaluronate Eye Drops with Systane in the Treatment of Dry Eye Syndrome. Therapeutics and Clinical Risk Management. 2015.
9. Chiambaretta F, et al. A Randomized, Controlled Study of the Efficacy and Safety of a New Eye Drop Formulation for Moderate to Severe Dry Eye Syndrome. European Journal of Ophthalmology. 2017.
10. Doan S, et al. Comparison of the Effect of a Hyaluronate-Trehalose Solution to Hyaluronate Alone on Ocular Surface Disease Index in Patients with Moderate to Severe Dry Eye Disease. Current Medical Research and Opinion. 2018.

This article is for general education. It is not a substitute for an exam, diagnosis, or treatment. Consult an eye-care professional.

How well hydrated is the ocular surface?