Association Between Screen Time, Digital Gaming Addiction, and Ocular Surface Parameters in School-Aged Children: A Cross-Sectional Study

Year 2025, Volume: 11 Issue: 3, 228 - 242, 30.08.2025

Fatma Sümer , Merve Yazıcı

Abstract

Objective: This study aimed to evaluate whether screen exposure duration and the level of digital gaming addiction are associated with subjective ocular surface symptoms and objective tear film function tests in children.
Method: This cross-sectional study was conducted with 90 children aged between 8 and 14 years. Participants were divided into two groups: a symptomatic group (n = 45), consisting of children reporting ocular complaints such as burning, stinging, or itching, and a control group (n = 45) without such symptoms. All participants completed the Ocular Surface Disease Index (OSDI) questionnaire. Tear film function was assessed using tear break-up time (BUT) and non-anesthetized Schirmer tests. Screen time and digital gaming addiction levels were measured using structured questionnaires and the Digital Gaming Addiction Scale for Children (DGAS-C).
Results: Weekday and weekend screen exposure times were significantly longer in the symptomatic group compared to the control group (p < 0.001). OSDI scores were markedly higher in the symptomatic group (p < 0.001); however, no statistically significant differences were observed between groups in terms of BUT and Schirmer test results (p > 0.05). Total and subscale scores of the DGAS-C were also significantly higher in the symptomatic group (p < 0.05). Among participants with daily screen time exceeding two hours, no significant differences were detected in objective test results or addiction levels (p > 0.05).
Conclusion: This study demonstrated that increased screen time is significantly associated with the presence of ocular surface symptoms in children. However, the elevation in subjective symptom scores does not always correspond to changes in objective tear function tests. The findings indicate that digital screen exposure constitutes a relevant risk factor for pediatric ocular health and that such effects may initially manifest as subjective complaints. These findings highlight digital screen exposure as an emerging pediatric ophthalmic concern, underscoring the urgency of early behavioral interventions.

Keywords

screen time , dry eye , OSDI , BUT , Schirmer , digital gaming addiction

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