Tear film change and ocular symptoms after reading printed book and electronic book: a crossover study

  • Pinnita Prabhasawat
  • Warinyupa Pinitpuwadol
  • Dawisa Angsriprasert
  • Pratuangsri Chonpimai
  • Manutsawin Saiman
Clinical Investigation



To evaluate and compare tear film changes and ocular symptoms after reading an electronic book (e-book) and a printed book.

Study design

Clinical and experimental.


Crossover study was conducted in 30 healthy volunteers, some of whom read an e-book and others a printed book for 20 minutes and then switched the following week. Tear meniscus height (TMH), non-invasive break-up time (NIBUT), fluorescein break up time (FBUT), corneal and conjunctival staining score, and questionnaires about seven ocular symptoms were evaluated before and after reading by both reading methods.


After reading an e-book, FBUT and NIBUT were significantly decreased (p<0.001for both). Similar to printed book readers (p=0.006, p=0.04, respectively). TMH and corneal and conjunctival staining score showed no significant differences in either group. Comparing the two groups, the e-book group showed more decrease in TMH, FBUT, and NIBUT (p>0.05). Ocular symptoms were significantly increased in both groups. The e-book group showed more increase in all symptoms, but only tearing (p=0.03) and burning sensation (p=0.02) were significantly different.


Reading an e-book affected tear film instability and significantly increased burning sensation and tearing to a larger extend than reading a printed book.


Tear film change Ocular symptoms Computer vision syndrome Dry eye Electronic book 



The authors gratefully acknowledge Ms.Julaporn Pooliam from the Division of Clinical Epidemiology, Department of Health Research and Development, Faculty of Medicine Siriraj Hospital for assistance with statistical analysis, Mr.Dhanach Dhirachaikulpanich from Faculty of Medicine Siriraj Hospital and Mr.Anupong Veeraburinon from the Research Division for preparing the manuscript.

Conflicts of interest

P Prabhasawat, None; W. Pinitpuwadol, None; D. Angsriprasert, None; P. Chonpimai, None; M. Saiman, None.


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Copyright information

© Japanese Ophthalmological Society 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand

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