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Background: Visual display terminal (VDT) use is a key risk factor for dry eye disease (DED). Visual display terminal (VDT) use reduces the blink rate and increases the number of incomplete blinks. However, the exact mechanisms causing DED development from VDT use have yet to be clearly described. Purpose: The purpose of the study was to conduct a review on pathophysiological mechanisms promoting VDT-associated DED. Methods: A PubMed search of the literature investigating the relationship between dry eye and VDT was performed, and relevance to pathophysiology of DED was evaluated. Findings: Fifty-five articles met the inclusion criteria. Several pathophysiological mechanisms were examined, and multiple hypotheses were extracted from the articles. Visual display terminal (VDT) use causes DED mainly through impaired blinking patterns. Changes in parasympathetic signalling and increased exposure to blue light, which could disrupt ocular homeostasis, were proposed in some studies but lack sufficient scientific support. Together, these changes may lead to a reduced function of the tear film, lacrimal gland, goblet cells and meibomian glands, all contributing to DED development. Conclusion: Visual display terminal (VDT) use appears to induce DED through both direct and indirect routes. Decreased blink rates and increased incomplete blinks increase the exposed ocular evaporative area and inhibit lipid distribution from meibomian glands. Although not adequately investigated, changes in parasympathetic signalling may impair lacrimal gland and goblet cell function, promoting tear film instability. More studies are needed to better target and improve the treatment and prevention of VDT-associated DED. This research was partly funded by NFR 271555 grant by the Norwegian Research Council, through the Medical Student Research Program. D.A. Dartt was supported by grants from the US NIH: R01 EY019470, R01 EY029789 and R01 EY021292.

Key Points Question What are the trends of workplace violence during physicians’ careers, and what are the individual and work-related factors of experiencing workplace violence in a long-term follow-up? Findings In this 20-year longitudinal study of 2 cohorts including 893 Norwegian physicians surveyed 6 years apart, the prevalence of multiple threats and acts of violence declined throughout physicians’ careers. Both threats and acts of violence were significantly associated with male gender, young physician cohort, and psychiatry; threats of violence were also associated with low levels of the vulnerability trait. Meaning These findings suggest that efforts to prevent workplace violence should include early-career and male physicians and may benefit from focusing on physician personality traits., This cohort study examines the incidence of violence and threats of violence against physicians in Norway during a 20-year period., Importance Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians. Objective To investigate WPV trends during Norwegian physicians’ careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study. Design, Setting, and Participants This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020. Exposures Medical career during 20 years in Norway. Main Outcomes and Measures WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures. Results At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (β = −1.06; 95% CI, −1.31 to −0.09; P