CLINICAL TRIAL

Randomized Trial of Desktop Humidifier for Dry Eye Relief in

Computer Users
Michael T. M. Wang,1 Evon Chan, BOptom,1,2 Linda Ea, BOptom,1,2 Clifford Kam, BOptom,1,2 Yvonne Lu, BOptom,1,2
Stuti L. Misra, PhD, BOptom, FAAO,1 and Jennifer P. Craig, PhD, MCOptom, FAAO1*

SIGNIFICANCE: Dry eye is a frequently reported problem among computer users. Low relative humidity environ-
ments are recognized to exacerbate signs and symptoms of dry eye, yet are common in offices of computer opera-
tors. Desktop USB-powered humidifiers are available commercially, but their efficacy for dry eye relief has not been
established.
PURPOSE: This study aims to evaluate the potential for a desktop USB-powered humidifier to improve tear-film
parameters, ocular surface characteristics, and subjective comfort of computer users.
METHODS: Forty-four computer users were enrolled in a prospective, masked, randomized crossover study. On
separate days, participants were randomized to 1 hour of continuous computer use, with and without exposure
to a desktop humidifier. Lipid-layer grade, noninvasive tear-film breakup time, and tear meniscus height were mea-
sured before and after computer use. Following the 1-hour period, participants reported whether ocular comfort
was greater, equal, or lesser than that at baseline.
RESULTS: The desktop humidifier effected a relative difference in humidity between the two environments of
Author Affiliations:
+5.4 ± 5.0% (P < .001). Participants demonstrated no significant differences in lipid-layer grade and tear menis- 1
Department of Ophthalmology,
cus height between the two environments (all P > .05). However, a relative increase in the median noninvasive tear- New Zealand National Eye Centre,
film breakup time of +4.0 seconds was observed in the humidified environment (P < .001), which was associated The University of Auckland, Auckland,
with a higher proportion of subjects reporting greater comfort relative to baseline (36% vs. 5%, P < .001). New Zealand
2
CONCLUSIONS: Even with a modest increase in relative humidity locally, the desktop humidifier shows potential Department of Optometry and Vision
to improve tear-film stability and subjective comfort during computer use. Science, New Zealand National Eye
Trial registration no: ACTRN12617000326392. Centre, The University of Auckland,
Auckland, New Zealand
Optom Vis Sci 2017;94:1052–1057. doi:10.1097/OPX.0000000000001136 *jp.craig@auckland.ac.nz
Copyright © 2017 American Academy of Optometry

Dry eye and ocular discomfort are commonly reported among
computer users.1–6 The dramatic increase in the use of computers,
in both the home and work environment, has been accompanied by
a rise in the prevalence of dry eye symptoms.3 Sustained visual
concentration on computer monitors can decrease blinking fre-
quency and potentially increase the exposed ocular surface
area.6–13 This discourages secretion and distribution of meibomian
lipids, contributing to tear-film instability and promoting tear-film
evaporation and associated dry eye symptoms.14–16
Low-relative-humidity environments are recognized to exacer-
bate the signs and symptoms of dry eye,17–20 yet offices of com-
puter operators are typically highly air conditioned or centrally
heated. Greater water vapor pressure differences between the ocu-
lar surface and the surrounding environment can facilitate in-
creased aqueous evaporation from the tear film, further reducing
tear-film stability and ocular comfort.21
Both computer use and low environmental relative humidity can
drive borderline dry eye patients toward developing manifest symp-
toms, and efforts need to be made to tackle this common prob-
lem.18 Current remedies to alleviate dry eye symptoms in the
office environment include regular instillation of lubricating eye
drops, although the action of these supplements is typically
short-lived.4,22 Blinking exercises have the potential to improve
comfort for computer users23; however, the maintenance of associ-
ated benefits requires significant motivation and compliance.
Increasing periocular humidity by wearing goggles improves tear-
film quality and subjective comfort, but lacks cosmetic appeal in
the workplace.24
USB-powered desktop humidifiers are available commercially
and are advertised to increase relative humidity locally. However,
their efficacy in dry eye relief has not yet been established. The cur-
rent study was conducted to evaluate the effect of a desktop hu-
midifier on the tear film, ocular surface, and subjective comfort
of computer users.
METHODS
Subjects
This prospective, masked, randomized crossover study followed
the tenets of the Declaration of Helsinki and was approved by the
institutional human participants ethics committee. The study was
registered as a clinical trial (ACTRN12617000326392) and abides
by the CONSORT statement (http://www.consort-statement.org/).
Subjects were required to be 16 years or older and non–contact
lens wearer, with no history of major systemic or ocular disease
(other than dry eye), no previous ocular surgery, and no use of top-
ical or systemic medications known to affect the eye. Eligible par-
ticipants were enrolled after providing written informed consent
and were required to attend three visits on separate days at the

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 Humidifier for Dry Eye Relief — Wang et al.

Ocular Surface Laboratory within The University of Auckland

Eye Clinic.
A total of 46 individuals were tested for eligibility from which
44 eligible participants were enrolled and completed the study,
exceeding the sample size requirement for the desired study
power. The designated outcome for determining sample size was
noninvasive tear-film breakup time. Power calculations showed
that a minimum of 41 participants was required, to detect a clini-
cally significant difference of 5 seconds, in any of the four pairwise
comparisons, with 80% power (β = 0.2) at a two-sided statistical
significance level of 5% (α = 0.05). The SD of normal values was
estimated to be at 8 seconds.25 Sample size estimates were deter-
mined using a uniform nonparametric adjustment, with PASS 2002
(NCSS Statistical Software LLC, Kaysville, UT).

Enrollment Visit
During the enrolment visit, the McMonnies Dry Eye question-
naire was administered, to grade the severity of dry eye symptoms.
Although acknowledged to have limitations,26 particularly in stud-
ies involving repeat evaluations, this screening questionnaire was
selected as a validated means of gauging dry eye severity and
identifying risk factors. Participants were then asked to report
their average duration of computer use per day.
Aqueous tear production was evaluated using a phenol red thread
hooked over the lateral third of the lower eyelid, with the wetted
length measured after 15 seconds. Sodium fluorescein dye was
applied to the bulbar conjunctiva in order to evaluate the localized
corneal and conjunctival epithelial desiccation. The staining was
recorded according to the modified Oxford grading scheme,27
where the nasal and temporal conjunctivas were each divided
into three areas and the cornea into five areas. Staining in each area
was graded from 0 to 5 with increasing confluence and summed to
provide a maximum ocular surface staining score of 55.
Randomization and Masking of Intervention
During the two subsequent visits, participants were required
to engage in 1 hour of continuous computer use in the same air-
conditioned clinic room. One visit was randomized (by computer-
generated random number allocation, generated by an independent
researcher and applied to sequentially enrolled participants) to
exposure of the USB-powered desktop humidifier (Homi Ltd.,
Guangdong, China), whereas in the other visit the humidifier was
turned off. The visits occurred at the same time of the day (to within
1 hour) on two separate days within the same week. All visits oc-
curred in the same location. The arrangement of the computer,
desktop humidifier, humidity and temperature sensor, and desk
and chair within the room was kept the same (Fig. 1). The desktop
humidifier was placed 60 cm away from the participant's seat. The
humidity and temperature sensor was placed at eye level above an
adjustable paper tray, 30 cm away from the participant's face.
Participant masking was achieved by wrapping the humidifier
with an opaque black plastic sheet to conceal the indicator light.
Participants were informed that water vapor produced by the
humidifier may or may not be apparent, depending on the environ-
mental conditions of the room.
Measurements
The investigators conducting measurements were masked to
treatment exposure. Measurements were conducted before and
after the 1-hour period of computer use. Temperature and relative
humidity were measured locally with a high-precision, rapid-response
FIGURE 1. Diagram of the relative positioning of desktop humidifier
and the humidity and temperature sensor. The desktop humidifier
was placed 60 cm away from the participant's seat and wrapped with
an opaque black plastic sheet to conceal the indicator light. The
humidity and temperature sensor was placed at eye level, above an
adjustable paper tray, 30 cm away from the participant's face. The
diagram is not drawn to scale.
thermohygrometer (HP21 Thermohygrometer; Rotronic Instru-
ments, West Sussex, U.K.), situated in close proximity to the
participant's face (Fig. 1). The precision estimate of the relative
humidity sensor was ±1% and the resolution was ±0.02%.
The clinical tests were performed in ascending order of invasive-
ness, in order to minimize the impact on tear-film physiology for
subsequent tests (Table 1). The lower tear meniscus height was
determined using a high-magnification digital image under diffuse
illumination, which was subsequently calibrated via graticule
by ImageJ software (National Institutes of Health, Bethesda,
MD). Three measurements near the center of the lower meniscus
were averaged.
Lipid-layer grade and the primary outcome measure, noninva-
sive tear-film breakup time, were assessed by the Tearscope Plus
(Keeler, U.K.), with fine grid insert for noninvasive tear-film breakup
time measurements. Lipid-layer grading was based on the Guillon-
Keeler grading system: grade 1, open meshwork; grade 2, closed mesh-
work; grade 3, wave or flow; grade 4, amorphous; grade 5, colored
fringes; grade 0, noncontinuous layer due to nonvisibility of lipid or to
the presence of abnormal colored fringes.28 Noninvasive tear-film
breakup time was recorded as the time taken, following a blink, for
the grid reflection to first show distortion, while the subject main-
tained fixation and was requested to refrain from blinking. Three
consecutive breakup time measurements were averaged.

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Humidifier for Dry Eye Relief — Wang et al.
TABLE 1. Sequence of clinical measurements performed at each visit
Enrolment visit
1. McMonnies Dry Eye Questionnaire
2. Phenol red thread test
3. Sodium fluorescein staining
Intervention visits
Measurements immediately before 1-h exposure period
1. Tear meniscus height
2. Tear-film lipid-layer grade
3. Noninvasive tear-film breakup time
Measurements immediately after 1-h exposure period
1. Subjective ocular comfort relative to baseline
2. Tear meniscus height
3. Tear-film lipid-layer grade
4. Noninvasive tear-film breakup time
Subjectively, participants were requested to compare ocular
comfort relative to baseline, following the 1-hour period of com-
puter use, using a force-choice, three-point scale: greater, equal,
or lesser comfort.
Statistical Analysis
Statistical analyses were performed using GraphPad Prism ver-
sion 6.02 (http://www.graphpad.com). Comparisons of continuous
variables (relative humidity, temperature, tear meniscus height)
between and within groups were performed using paired t tests,
where normal distribution had been confirmed by the Kolmogorov-
Smirnov test (P > .05). Non–normally distributed measures (noninva-
sive tear-film breakup time) were logarithmically transformed
before being assessed by paired t tests. Ordinal data (lipid-layer
grade) were analyzed using Wilcoxon signed rank tests. Categorical
data (subjective comfort) were compared using χ2 tests or Fisher
exact tests. All tests were two-tailed, and P < .05 was considered
significant. Statistical correlations between changes in relative hu-
midity, noninvasive tear-film breakup time, and subjective comfort
were tested using Spearman rank correlation coefficient. All con-
tinuous data are presented as mean ± SD, ordinal data as median
(95% confidence interval), and categorical data as number of par-
ticipants (% of participants), unless otherwise stated.
RESULTS
Two prospective participants failed to meet the eligibility
criteria and were not enrolled. Trial recruitment took place over a
3-month period (June to August 2012) and ceased when a sample
size to meet adequate statistical power was reached (with addi-
tional 5 to 10% overrecruitment to mitigate against potential drop-
out). A total of 44 enrolled subjects completed both arms of the
study and provided full data for analysis.
The mean ± SD age of the 44 enrolled subjects (24 female, 20
male subjects) was 21 ± 3 years (range, 16 to 37 years). Twenty-
one subjects (48%) were spectacle wearers. Baseline characteris-
tics and measurements are listed in Tables 2 and 3, respectively.
On average, enrolled subjects reported 4.4 ± 2.1 hours of computer
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use daily. The low McMonnies Dry Eye Questionnaire scores and
minimal ocular sodium fluorescein staining showed that dry eye
status was not of a severe degree in the current study. There were
no statistically significant differences in baseline measurements
of the participants prior to 1 hour of computer use with and without
exposure to the desktop humidifier (all P > .05). No adverse events
were reported during the trial.
Local Relative Humidity and Temperature
Relative humidity rose significantly from baseline with the desk-
top humidifier (+3.1 ± 3.1%, P < .001). Without the humidifier,
relative humidity levels dropped (−2.3 ± 4.4%, P = .001). The
desktop humidifier thus facilitated an overall difference in relative
humidity change of +5.4 ± 5.0% between the two environments
(P < .001). There were no significant changes in local room tem-
peratures over the 1-hour period in both groups (both P > .05).
Tear Film and Ocular Surface Characteristics
In both groups, no significant changes in tear meniscus height,
lipid-layer grade, or tear meniscus height were observed over the
1-hour period (all P > .05).
Noninvasive tear-film breakup time improved following humidi-
fier exposure (P = .01), whereas a significant reduction in breakup
time measurements was observed without the humidifier (P = .005).
Overall, the desktop humidifier effected a statistically significant
difference in the median change of noninvasive tear-film breakup
time of +4.0 seconds between groups (P < .001, Fig. 2).
Subgroup analysis showed no significant difference in the over-
all effect of the desktop humidifier on noninvasive tear-film
breakup time between spectacle wearers and non–spectacle
wearers (median, +4.0 vs. +3.8 seconds; P = .54). Changes in non-
invasive tear-film breakup time and local relative humidity were
significantly correlated (Spearman ρ = 0.59, P < .001).
Subjective Comfort
Following 1 hour of continuous computer use, a greater propor-
tion of participants exposed to the desktop humidifier reported an
improvement in subjective comfort than those without (36% vs.
5%, P < .001, Fig. 3). A significantly lower proportion of partici-
pants in the humidified environment reported a reduction in ocular
comfort (7% vs. 48% P < .001). Subjective comfort was signifi-
cantly correlated with changes in noninvasive tear-film breakup
TABLE 2. Baseline characteristics of subjects
Characteristic
Age, y 21.3 ± 3.1
Female sex 24 (55%)
Spectacle wear 21 (48%)
Computer use per day, h 4.4 ± 2.1
McMonnies Dry Eye Questionnaire 6 (0–12)
Phenol red thread test, mm 15 (3–38)
Sodium fluorescein staining 3 (0–12)
Data are presented as mean ± SD, number of subjects (% of subjects),
or median (range). Asterisks denote statistically significant differ-
ences (P < .05).
1054
 Humidifier for Dry Eye Relief — Wang et al.

TABLE 3. Measurements before and after 1 hour of continuous computer use with or without humidifier
Measurement With humidifier (n = 44) Without humidifier (n = 44) P
Relative humidity, % Baseline 47.3 ± 9.4 47.2 ± 8.3 .96
1h 50.4 ± 9.9 44.9 ± 9.2 <.001*
P <.001* .001*
Difference 3.1 ± 3.1 −2.3 ± 4.4 <.001*
Temperature, °C Baseline 22.3 ± 1.3 22.1 ± 1.0 .56
1h 22.5 ± 1.0 22.3 ± 0.9 .43
P .45 .45
Difference 0.2 ± 0.7 0.2 ± 0.5
Tear-film lipid-layer grade Baseline 3 (3–4) 3 (3–4) .22
1h 3 (3–4) 3 (3–4) .27
P .64 .74
Noninvasive tear-film breakup time, s Baseline 7.0 (6.4–8.6) 8.0 (7.4–8.8) .23
1h 9.0 (8.0–11.3) 6.4 (5.7–7.4) .001*
P .01* .005*
Difference 1.8 (0.8–2.7) −1.2 (−2.3 to −0.3) <.001*
Tear meniscus height, mm Baseline 0.13 ± 0.07 0.14 ± 0.10 .75
1h 0.17 ± 0.11 0.17 ± 0.12 .87
P .09 .15
Difference 0.04 ± 0.10 0.03 ± 0.12 .76
Subjective comfort at 1 h relative Greater 16 (36%) 2 (5%) <.001*
to baseline Equal 25 (57%) 21 (48%) .52
Lesser 3 (7%) 21 (48%) <.001*
Data are presented as mean ± SD, median (95% confidence interval), or the number of subjects (% of subjects). Asterisks denote statistically significant
differences (P < .05).

time (Spearman ρ = 0.46, P < .001). No adverse events were re-

ported during this study.

DISCUSSION

The modern office environment exposes the eyes to a number of

provocative stimuli, including continual computer use and low
relative humidity.1,2,4,21 Dry eye associated with computer use
is commonly reported.1–6 The findings of the current study dem-
onstrate a reduction in tear-film stability measurements in par-
ticipants following 1 hour of continuous computer use in the
absence of humidifier exposure. The decreased tear-film stabil-
ity was reflected in subjective comfort, with almost half (48%) of
the participants in the control arm (no humidifier) reporting a re-
duction in subjective ocular comfort relative to baseline.
Computer operation and sustained visual concentration on screen
monitors can reduce blinking frequency6–12 by a factor of two to three
times,2 relative to that under relaxed conditions. Blinking fre-
quency can be suppressed by the high visual and cognitive load,
which overrides other sensory stimuli and cues.11,13 Among other
functions, the blinking mechanism serves to promote incorporation
of meibomian secretions into the tear-film lipid layer, inhibiting
aqueous tear evaporation.15,23 It also facilitates the even distribu- FIGURE 2. Differences in noninvasive breakup time (NIBUT) after
tion of the tear film over the ocular surface.15,23 Reduced blinking 1 hour of continuous computer use, with or without humidifier. Each
can therefore affect lipid flow and result in inadequate coverage point represents the difference in NIBUT of an individual subject. Bars
of the ocular surface, contributing toward tear-film thinning, represent the median difference in NIBUT. Error bars represent the
95% confidence interval. Asterisks denote statistically significant
tear-film breakup, and the formation of dry spots. This tear-film
differences (P < .05).
instability can be associated with increased tear evaporation and

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Humidifier for Dry Eye Relief — Wang et al.

that changes in relative humidity can affect tear-film stability and

FIGURE 3. Subject comfort after 1 hour of continuous computer use
with or without humidifier, relative to baseline. Data on the bars are
the percentages of subjects who expressed greater, equal, and lesser
comfort. Asterisks denote statistically significant differences (P < .05).
the consequent development of dry eye symptoms.2,3,14–16,23 Further-
more, visual concentration and relative up-gaze can widen the palpe-
bral aperture, increasing the exposed ocular surface area, which also
encourages thinning and evaporation of the tear film.2,29,30
Low-relative-humidity environments are recognized to exacerbate
the severity of dry eye and are common in modern workplaces,17–20
with the widespread use of air conditioning and central heating. A
greater evaporative driving force results from the larger water vapor
pressure gradients between the ocular surface and the surrounding
environment. This increases the amount and speed of aqueous tear
evaporation, causing ocular discomfort with reduced tear-film stabil-
ity and cooling of the corneal and conjunctival surfaces.14,19,21
The USB-powered desktop humidifier was shown to effect a
modest relative change in humidity of +5.4% between the two
environments. Nevertheless, a statistically and clinically signifi-
cant difference was observed in tear-film stability changes between
groups, with the humidifier effecting an overall increase in median
change of noninvasive tear-film breakup time by 4.0 seconds. This
may be potentially explained by the reduced water vapor pressure
gradients between the ocular surface and surrounding environment
contributing toward decreased tear evaporation. Furthermore, a
significant correlation was observed between the changes in rela-
tive humidity and noninvasive tear-film stability. The changes in
tear-film stability were also associated with greater subjective com-
fort among participants exposed to the desktop humidifier than
those without. This is consistent with previous research that reports
perceived dry eye symptoms.20,24 The increased local relative
humidity effected by the desktop humidifier may reduce water vapor
pressure gradients between the ocular surface and the surround-
ing environment, potentially contributing toward decreased aqueous
tear-film evaporation and improvements in tear-film stability.20,24
Local relative humidity was noted to drop by 2.3% in the control
arm (no humidifier), which is likely attributed to the underlying air-
conditioned environment of the clinic room. Although it is known
that increased relative humidity can reduce blinking frequency,31
no change in lipid-layer grade was detected with the modest
increase in relative humidity effected by the desktop humidifier.
Efforts were made to ensure that the study was masked. The
investigators conducting clinical measurements at baseline and
postexposure were masked to the allocation status of the partic-
ipants. Participants were informed that the humidifier may or may
not produce water vapor depending on the environmental condi-
tions of the room, and the indicator light of the humidifier was
concealed by wrapping the device in an opaque black plastic sheet.
Nevertheless, given the randomized crossover design of the study
and the difficulty in concealing water vapor production, it is recog-
nized that complete participant masking may not have been fully
achievable. This is acknowledged to introduce some risk of bias to
subjective reports of ocular comfort. Despite this, the investigator-
masked objective findings of tear-film stability improvement alone
would suggest that humidifier exposure is capable of delivering clin-
ically significant benefits to computer users.
The findings show that a USB-powered desktop humidifier can
potentially provide a means by which computer users may achieve
some amount of symptomatic relief from dry eye. In being relatively
simple to use and minimally disruptive to computer work, the
desktop humidifier offers some advantages over other potential
remedies, including lubricating eye drops, blinking exercises,
and moisture goggles. An earlier study described the efficacy of
an electrospray device, which delivered positively charged liquid
droplets to the ocular surface. Although this device also provides
minimal interruption to computer work, there were some minor
safety concerns regarding the potential exposure and inhalation
of castor oil particles.32 In contrast, the desktop humidifier pro-
duces only water vapor, and no adverse events were reported by
participants in the current study.
In conclusion, although the USB-powered desktop humidifier in
this study produced only a modest increase in relative humidity lo-
cally, significant improvements in tear-film stability and subjective
comfort during computer use were demonstrated. The desktop hu-
midifier therefore shows potential for dry eye relief for computer
users in the modern office environment.

ARTICLE INFORMATION
Submitted: October 10, 2016
Accepted: August 29, 2017
Funding/Support: None of the authors have reported
funding/support.
Conflict of Interest Disclosure: None of the authors have
reported a conflict of interest.
Author Contributions and Acknowledgments: Formal
Analysis, Validation, Visualization, Writing – Original
Draft: MTMW; Data Curation, Project Administration,
Writing – Review & Editing: EC, LE, CK, YL; Project
Administration, Supervision, Writing –Review &
Editing: SLM; Conceptualization, Funding Acquisition,
Investigation, Methodology, Project Administration,
Resources, Supervision, Validation, Writing – Review &
Editing: JPC.
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