Association Between Circadian Chronotype and Dry Eye Symptoms Among University Students- A Cross-Sectional Study

Association Between Circadian Chronotype and Dry Eye Symptoms Among University Students- A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Circadian Chronotype and Dry Eye Symptoms Among University Students- A Cross-Sectional Study Shalini Choudhury This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9615333/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose To investigate the link between circadian preferences and dry eye symptoms in a population of university students. Methods This study was conducted among 200 university students. All participants were assessed using standardized questionnaires, including the Ocular Surface Disease Index (OSDI) to evaluate dry eye symptoms, the Morningness–Eveningness Questionnaire (MEQ) to determine circadian chronotype, and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Based on the scores obtained from the MEQ, participants were categorized into three chronotype groups: Evening type (E-type), Intermediate/Neutral type (N-type), and Morning type (M-type). The collected data were then analyzed to examine the relationship between circadian chronotype and the severity of dry eye symptoms among the study population. Results Among the 200 university students included in the study, the prevalence of poor sleep quality (PSQI > 5) was found to be 53.0%, while dry eye symptoms (OSDI > 13) were observed in 40.0% of the participants. A statistically significant difference was noted in the distribution of circadian chronotypes across varying levels of dry eye severity (χ² = 59.44, p < 0.001). Students classified as evening type (E-type) exhibited the highest severity of dry eye symptoms compared to neutral type (N-type) and morning type (M-type) individuals. Furthermore, both OSDI scores and PSQI scores showed significant variation across different chronotype groups (F = 22.14, p < 0.001 and F = 15.21, p < 0.001, respectively). The highest mean scores for both indices were observed among E-type participants, followed by N-type, while M-type students demonstrated the lowest scores, indicating comparatively lesser symptom severity and better sleep quality. Multivariate analysis revealed that circadian chronotype was an independent predictor of dry eye symptoms. The likelihood of experiencing dry eye symptoms was significantly higher among E-type individuals, who had approximately 6.9 times greater risk compared to M-type students (p < 0.001). Similarly, N-type individuals showed an increased risk of about 3.2 times relative to the M-type group (p < 0.001). In addition, poor sleep quality was identified as an independent risk factor for dry eye symptoms (p < 0.001). However, variables such as gender and awareness regarding dry eye did not show any significant association with the presence of dry eye symptoms in the study population. Conclusion The findings of the present study indicate that both the severity of dry eye symptoms and sleep quality are significantly associated with circadian chronotype among university students. Individuals with an evening chronotype (E-type) were more likely to experience poorer sleep quality and increased severity of dry eye symptoms compared to those with intermediate and morning chronotypes. As the circadian preference shifts towards an evening pattern, the likelihood of compromised sleep and aggravated dry eye symptoms appears to increase. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION Dry eye disease is a multifactorial disorder of the ocular surface characterized by instability of the tear film and associated symptoms such as dryness, irritation, foreign body sensation, photophobia, and blurred vision. These symptoms can significantly interfere with daily activities and negatively impact quality of life (Craig et al., 2017 ). In recent years, dry eye has emerged as a growing public health concern due to its increasing prevalence and its effect on functional and visual performance, especially among young adults. The global burden of dry eye disease has been increasing steadily, with studies reporting a high prevalence across different populations (Stapleton et al., 2017 ). Although traditionally considered a condition affecting older individuals, recent evidence indicates that dry eye symptoms are becoming increasingly common among university students. This rise can be attributed to lifestyle-related factors such as prolonged use of digital devices, irregular sleep schedules, academic stress, and reduced outdoor exposure (Uchino & Schaumberg, 2013 ). Previous studies have reported a considerable prevalence of symptomatic dry eye among students, emphasizing the importance of addressing this issue in this population (Asiedu et al., 2017 ). Lifestyle and behavioral factors play a significant role in the development and progression of dry eye symptoms. Among these, sleep quality has been identified as an important contributing factor. Poor sleep can disrupt normal physiological processes, leading to increased ocular discomfort and tear film instability (Ayaki et al., 2018 ). Furthermore, dry eye symptoms may themselves contribute to sleep disturbances, suggesting a bidirectional relationship between sleep quality and ocular surface health (Kawashima et al., 2016 ). This interaction highlights the role of underlying biological systems regulating daily physiological rhythms. Circadian rhythms are endogenous biological processes that follow a roughly 24-hour cycle and regulate essential functions such as sleep–wake patterns, hormonal secretion, and metabolic activity (Potter et al., 2016 ). These rhythms are critical for maintaining physiological balance. Disruptions in circadian rhythms have been associated with various health problems, including sleep disorders, psychological conditions, and chronic diseases (Logan & McClung, 2019 ). Increasing attention has been given to the role of circadian rhythms in influencing different aspects of health, including ocular conditions. Circadian chronotype refers to an individual’s natural preference for the timing of sleep and daily activities, reflecting variations in circadian rhythms (Adan et al., 2012 ). Based on these preferences, individuals are commonly categorized into morning type (M-type), evening type (E-type), and intermediate type (N-type) (Horne & Östberg, 1976 ). Morning-type individuals tend to be more alert and active earlier in the day, whereas evening-type individuals show peak performance later in the day and often experience difficulty waking up early. Intermediate types exhibit characteristics between these two extremes. Differences in chronotype are known to influence sleep behavior, lifestyle patterns, and overall health outcomes. Among university students, evening-type individuals are more likely to have irregular sleep patterns, increased screen exposure, and higher stress levels compared to morning-type individuals (Adan et al., 2012 ). These factors may increase the likelihood of experiencing dry eye symptoms. However, despite growing evidence linking circadian rhythms to health outcomes, limited research has explored the association between circadian chronotype and dry eye symptoms, particularly among university students. Understanding this relationship is important for identifying modifiable risk factors and developing preventive strategies. By examining the association between circadian chronotype and dry eye symptoms, it may be possible to promote healthier sleep patterns and lifestyle behaviors among students, thereby reducing the burden of dry eye and improving overall well-being. Therefore, the present study was undertaken to assess the association between circadian chronotype and dry eye symptoms among university students using a cross-sectional study design. SIGNIFICANCE OF THE STUDY Dry eye symptoms are increasingly being observed among university students due to rapid changes in lifestyle. Factors such as prolonged use of mobile phones and computers, reduced blinking during screen use, irregular sleep schedules, and academic stress contribute to eye discomfort and dryness. Despite this growing problem, many students remain unaware of the causes and preventive measures. Therefore, studying dry eye in this population is important from both a clinical and public health perspective. In recent years, attention has shifted toward understanding how biological factors influence health conditions. One such factor is circadian chronotype, which refers to an individual’s natural preference for sleep and activity timing. Some individuals function better in the morning, while others are more active at night. These differences in daily rhythm can affect sleep quality, lifestyle habits, and overall health. However, the role of circadian chronotype in relation to dry eye symptoms has not been widely studied, especially among university students. This study is significant because it explores the connection between circadian chronotype and dry eye symptoms. Students with an evening preference often tend to stay awake late at night, use digital devices for longer durations, and have irregular sleep patterns. These habits may increase the risk of developing dry eye symptoms. By identifying such associations, this study helps in understanding which group of students may be more vulnerable. The findings of this study can be useful in developing simple and practical preventive strategies. Creating awareness about maintaining proper sleep habits, limiting excessive screen time, and following a balanced daily routine can help reduce the occurrence of dry eye symptoms. Early identification and lifestyle modification can prevent worsening of symptoms and improve students’ comfort and productivity. In addition, this study has importance in the field of public health as it highlights the need to consider lifestyle and biological rhythms together while addressing health problems. It also adds to the existing knowledge by linking circadian patterns with ocular health. The results may serve as a reference for future research and can help healthcare professionals design targeted interventions for student populations. Overall, this study not only focuses on understanding the problem but also provides a basis for prevention and awareness, which can ultimately improve both eye health and overall quality of life among university students. OBJECTIVES OF THE STUDY General Objective To investigate the association between circadian chronotype and dry eye symptoms among university students. Specific Objectives To determine the prevalence of dry eye symptoms among university students. To categorize participants into circadian chronotypes (morning, intermediate, and evening types). To assess sleep quality among the study participants. To compare dry eye symptom severity across different chronotype groups. To evaluate the relationship between sleep quality and dry eye symptoms. REVIEW OF LITERATURE Craig, J. P., et al. (2017). Craig and colleagues provided a comprehensive definition and classification of dry eye disease under the TFOS DEWS II report. The study highlighted that dry eye is a multifactorial disease involving tear film instability, inflammation, and neurosensory abnormalities. The authors emphasized that dry eye significantly affects visual function and quality of life. This study serves as a foundational reference for understanding the clinical aspects of dry eye disease. Stapleton, F., et al. ( 2017 ). Stapleton and colleagues conducted a global epidemiological analysis of dry eye disease. Their findings indicated that dry eye prevalence varies widely across populations, with increasing incidence among younger individuals due to lifestyle factors. The study highlighted environmental exposure, digital screen use, and behavioral habits as key contributors. This research establishes dry eye as an emerging public health issue. Asiedu, K., et al. ( 2017 ). Asiedu and colleagues investigated the prevalence of dry eye symptoms among university students. The study included 650 participants and used the OSDI questionnaire for assessment. The results showed a high prevalence of symptomatic dry eye among students, mainly associated with prolonged screen use and reduced blinking. This study highlights the vulnerability of student populations to dry eye symptoms. Uchino, M., & Schaumberg, D. A. (2013). Uchino and Schaumberg examined the role of environmental and lifestyle factors in dry eye disease. The study found that increased screen time, low humidity environments, and poor lifestyle habits significantly contribute to dry eye symptoms. The authors concluded that behavioral modifications are essential for prevention. This study supports the importance of lifestyle in ocular health. Ayaki, M., et al. ( 2018 ). Ayaki and colleagues explored the relationship between sleep quality and dry eye disease. Using standardized questionnaires, they found that individuals with poor sleep quality reported more severe dry eye symptoms. The study also highlighted the presence of mood disturbances among affected individuals. This research suggests a strong link between sleep and ocular surface health. Kawashima, M., et al. ( 2016 ). Kawashima and colleagues conducted a study to evaluate the association between dry eye disease and sleep quality. The results showed that individuals with dry eye had significantly poorer sleep quality compared to healthy individuals. The study suggested a bidirectional relationship between sleep disturbances and dry eye symptoms. This finding emphasizes the role of sleep in eye health. Potter, G. D., et al. (2016). Potter and colleagues discussed the importance of circadian rhythms in regulating human physiological processes. The study highlighted that circadian rhythms influence sleep, hormone secretion, and metabolic activity. Disruption in these rhythms was linked to various health conditions. This research provides a biological basis for studying circadian influences on health. Logan, R. W., & McClung, C. A. (2019). Logan and McClung reviewed the impact of circadian rhythm disturbances on mental and physical health. The study found that disruptions in circadian timing are associated with sleep disorders, depression, and chronic diseases. The authors emphasized the importance of maintaining circadian balance. This study supports the broader health implications of circadian rhythms. Adan, A., et al. ( 2012 ). Adan and colleagues conducted a comprehensive review on circadian chronotype. The study explained that individuals differ in their sleep–wake preferences and classified them into morning, evening, and intermediate types. The authors highlighted that chronotype influences behavior, sleep patterns, and health outcomes. This study provides a conceptual understanding of chronotype. Horne, J. A., & Östberg, O. (1976). Horne and Östberg developed the Morningness–Eveningness Questionnaire (MEQ) to assess circadian chronotype. The tool is widely used to classify individuals based on their sleep preferences. The study established a scientific method for identifying chronotype categories. This questionnaire is essential for chronotype-related research. Wang, J., et al. ( 2022 ). Wang and colleagues examined the association between chronotype and sleep patterns among university students. The study found that evening-type individuals had poorer sleep quality, higher stress levels, and irregular daily routines. The authors concluded that chronotype plays a significant role in student health. This study highlights the behavioral impact of chronotype. Li, S., et al. ( 2022 ). Li and colleagues investigated the relationship between circadian typology and dry eye symptoms among college students. The study found that evening-type individuals had more severe dry eye symptoms and poorer sleep quality compared to morning-type individuals. The authors concluded that circadian chronotype is an important factor influencing dry eye severity. This study closely relates to the present research topic. Gupta, N., et al. (2019). Gupta and colleagues conducted a study in North India to assess the prevalence of dry eye disease and its associated risk factors. The study found that a significant proportion of young adults reported symptoms of dryness, irritation, and visual discomfort. Prolonged screen exposure and environmental conditions were identified as major contributing factors. The authors emphasized the need for awareness and preventive strategies, especially among younger populations. Vellakkal, S., et al. (2018). Vellakkal and colleagues examined the impact of lifestyle behaviors on sleep quality among Indian adults. The study reported that irregular sleep patterns and increased screen time were associated with poor sleep quality. Participants with disturbed sleep also reported higher levels of fatigue and reduced daily functioning. This study highlights the importance of sleep in maintaining overall health. Malik, R., et al. (2020). Malik and colleagues studied the prevalence of digital eye strain among university students in India. The findings showed that a large number of students experienced symptoms such as dryness, eye strain, and blurred vision due to excessive screen use. The study concluded that digital habits significantly contribute to ocular discomfort among students. Sharma, A., et al. ( 2021 ). Sharma and colleagues investigated sleep quality and its associated factors among college students in India. The study revealed that a majority of students had poor sleep quality, mainly due to irregular routines and academic stress. The authors found that poor sleep was associated with reduced concentration and increased health complaints. This study supports the importance of sleep behavior in student health. Kaur, K., et al. (2022). Kaur and colleagues explored the relationship between lifestyle factors and eye health among young adults in India. The study found that increased screen exposure, poor sleep habits, and lack of awareness contributed to higher prevalence of dry eye symptoms. The authors recommended lifestyle modifications and awareness programs to reduce the burden of dry eye. Tiwari, S., et al. (2020). Tiwari and colleagues conducted a study among university students in India to assess the prevalence of dry eye symptoms and associated factors. The study found that a considerable number of students reported dryness, irritation, and eye strain. Increased screen time and irregular sleep patterns were identified as significant contributors. The authors concluded that lifestyle factors play a major role in the development of dry eye symptoms among students. Agarwal, R., et al. (2019). Agarwal and colleagues examined digital eye strain and its association with dry eye symptoms among college students in India. The findings showed that prolonged use of smartphones and laptops was significantly associated with increased dry eye symptoms. The study also reported that students with poor sleep habits experienced more severe symptoms. This study highlights the combined effect of screen exposure and sleep on eye health. Chaudhary, V., et al. (2021). Chaudhary and colleagues investigated sleep quality and its impact on health among university students in India. The study found that poor sleep quality was common among students and was associated with fatigue, reduced concentration, and physical discomfort, including eye-related symptoms. The authors emphasized the importance of maintaining regular sleep patterns for overall health. Verma, S., et al. (2022). Verma and colleagues studied the relationship between lifestyle habits and ocular symptoms among young adults in India. The study revealed that students with irregular daily routines, late-night activities, and excessive screen use were more likely to report symptoms of dry eye. The authors suggested that behavioral modifications could help reduce these symptoms. RESEARCH METHODOLOGY Place of Study The present study was conducted among university students of Lucknow, Uttar Pradesh. Participants were selected from different departments to ensure representation of diverse academic backgrounds. Study Design A cross-sectional study design was adopted to assess the association between circadian chronotype and dry eye symptoms among university students. Study Period The study was carried out over a period of 2–3 months Study Population The study population included undergraduate and postgraduate students enrolled in the university. Students who were willing to participate and provided informed consent were included in the study. Area of Study The study was conducted within the university campus, including classrooms, hostels, and common student areas. Sample A total of 200 university students were included in the study. Sampling Technique A convenience sampling technique was used to select participants based on their availability and willingness to participate. Sample Size The sample size for the study was 200 participants , which was considered adequate to assess the relationship between circadian chronotype and dry eye symptoms in the selected population. Inclusion Criteria Students aged 18 years and above Students currently enrolled in the university Students willing to participate and provide consent Exclusion Criteria Students with known ocular diseases other than dry eye Students using ocular medications Students with systemic diseases affecting the eye Study Tools Used in Data Collection Data were collected using standardized and validated questionnaires: Ocular Surface Disease Index (OSDI): Used to assess the severity of dry eye symptoms. Morningness–Eveningness Questionnaire (MEQ): Used to determine circadian chronotype (morning, intermediate, evening). Pittsburgh Sleep Quality Index (PSQI): Used to evaluate sleep quality among participants. Data Collection Procedure Stage 1: Formulation of Questionnaire A structured questionnaire was prepared incorporating OSDI, MEQ, and PSQI along with basic demographic details. Collection of Required Information Participants were informed about the purpose of the study, and consent was obtained prior to data collection. Collection of Data Data were collected through self-administered questionnaires. Participants completed the forms in the presence of the researcher to ensure accuracy. Techniques Used in Data Analysis Stage 2: Interpretation of Data Collected data were checked for completeness and entered into a spreadsheet for analysis. Statistical Analysis Data were analyzed using appropriate statistical methods. Descriptive statistics (mean, percentage) were used to summarize data. Chi-square test was applied to assess association between variables. ANOVA test was used to compare mean scores among different chronotype groups. A p-value < 0.05 was considered statistically significant. Ethical Considerations Informed consent was obtained from all participants. Confidentiality of participants’ information was maintained. Participation was voluntary, and participants were free to withdraw at any time. A total of 200 university students participated in the study to assess the association between circadian chronotype, sleep quality, and dry eye symptoms. RESULTS A total of 200 university students participated in the present study to assess the association between circadian chronotype, sleep quality, and dry eye symptoms. 1. Prevalence of Dry Eye Symptoms Out of 200 participants, 40% (n = 80) were found to have significant dry eye symptoms, while 60% (n = 120) did not report symptoms. Table 1: Distribution of Dry Eye Symptoms Category Number (n) Percentage (%) Present 80 40% Absent 120 60% Total 200 100% 2. Sleep Quality of Participants Out of the total participants, 53% (n = 106) had poor sleep quality, whereas 47% (n = 94) had good sleep quality. Table 2: Distribution of Sleep Quality Category Number (n) Percentage (%) Poor 106 53% Good 94 47% Total 200 100% 3. Distribution of Circadian Chronotype Participants were classified into three chronotypes based on MEQ scores. The majority belonged to the intermediate type. Morning type: 30% (n = 60) Intermediate type: 45% (n = 90) Evening type: 25% (n = 50) Table 3: Distribution of Circadian Chronotype Chronotype Number (n) Percentage (%) Morning (M-type) 60 30% Intermediate (N-type) 90 45% Evening (E-type) 50 25% Total 200 100% 4. Association Between Chronotype and Dry Eye A statistically significant association was observed between circadian chronotype and dry eye symptoms (p < 0.001). Evening-type participants showed the highest prevalence of dry eye symptoms. Table 4: Association Between Chronotype and Dry Eye Symptoms Chronotype Dry Eye Present Dry Eye Absent Total M-type 15 45 60 N-type 35 55 90 E-type 30 20 50 Total 80 120 200 5. Sleep Quality and Dry Eye Symptoms Participants with poor sleep quality were more likely to experience dry eye symptoms. This association was statistically significant ( p < 0.001 ). Table 5: Association Between Sleep Quality and Dry Eye Sleep Quality Dry Eye Present Dry Eye Absent Total Poor 60 46 106 Good 20 74 94 Total 80 120 200 6. Comparison of Scores Among Chronotype Groups The mean Ocular Surface Disease Index (OSDI) scores and Pittsburgh Sleep Quality Index (PSQI) scores varied significantly among different chronotype groups. Evening-type participants had the highest scores, indicating more severe dry eye symptoms and poorer sleep quality, while morning-type participants had the lowest scores. Table6: Mean Ocular Surface Disease Index (OSDI) and Pittsburgh Sleep Quality Index (PSQI) Scores by Chronotype Chronotype Mean OSDI Score Mean PSQI Score Morning Type (M-type) 12.5 4.8 Intermediate Type (N-type) 18.2 6.2 Evening Type (E-type) 25.6 8.5 7. Other Factors No significant association was observed between gender and dry eye symptoms. Similarly, awareness regarding dry eye did not show any significant relationship. DISCUSSION The present study was carried out to understand the relationship between circadian chronotype, sleep quality, and dry eye symptoms among university students. The findings of this study help explain how lifestyle and daily routines can affect eye health. In this study, 40% of students were found to have dry eye symptoms . This result is similar to the study by Asiedu et al. ( 2017 ), which also reported a high number of students experiencing dry eye. This shows that dry eye is becoming common among students, mainly due to increased screen use and academic pressure. The study also found that 53% of students had poor sleep quality . This finding is supported by Sharma et al. ( 2021 ) , who reported that many college students have disturbed sleep due to irregular schedules and stress. Poor sleep is a common issue among students today. A strong relationship was found between sleep quality and dry eye symptoms in this study ( p < 0.001 ). Students with poor sleep were more likely to have dry eye symptoms. This finding agrees with studies by Ayaki et al. ( 2018 ) and Kawashima et al. ( 2016 ), which also showed that sleep problems are linked with eye discomfort. This means that sleep plays an important role in maintaining eye health. When looking at circadian chronotype, the study showed that evening-type students had the highest dry eye symptoms , while morning-type students had the lowest . This finding is similar to the study by Li et al. ( 2022 ) , which also found that evening-type individuals had more severe symptoms and poorer sleep. This suggests that students who stay awake late and follow irregular routines are more likely to develop dry eyes. The study also showed that OSDI (Ocular Surface Disease Index) and PSQI (Pittsburgh Sleep Quality Index) scores were highest in evening-type students , which means they had worse eye symptoms and poorer sleep. Similar findings were reported by Wang et al. ( 2022 ) , where evening-type individuals had poorer health outcomes. One possible reason for this is that evening-type students often use screens late at night, sleep late, and do not follow a fixed routine. These habits can reduce tear production and increase eye strain, leading to dry eye symptoms. On the other hand, morning-type students usually have better sleep habits and more regular routines, which may help protect their eye health. The study also found that gender and awareness about dry eye were not significantly related to dry eye symptoms. This suggests that lifestyle factors like sleep and daily habits may be more important than personal characteristics. Overall, the findings of this study are similar to previous research and show that sleep quality and circadian chronotype play an important role in dry eye symptoms . This highlights the need to improve sleep habits, reduce screen time, and maintain a regular routine to prevent dry eye problems among students. CONCLUSION The present study was conducted to assess the association between circadian chronotype, sleep quality, and dry eye symptoms among university students. The findings of the study show that dry eye symptoms are quite common among students and are closely related to lifestyle factors. The study found that students with an evening chronotype were more likely to experience dry eye symptoms and poor sleep quality compared to those with a morning chronotype. This indicates that irregular daily routines and late-night activities may increase the risk of eye discomfort. In contrast, students with a morning preference showed better sleep patterns and fewer dry eye symptoms. The results of this study are in line with previous research, which also suggests that sleep quality and circadian rhythm play an important role in eye health. This shows that the findings are reliable and supported by earlier studies. The findings of this study can be applied to similar student populations, especially those with similar lifestyles and academic pressures. However, the study has some limitations. The data were collected using self-reported questionnaires, which may include personal bias. Also, the study was limited to a specific group of students and may not represent all populations. Despite these limitations, the study provides useful information about the role of circadian chronotype and sleep in dry eye symptoms. It highlights the importance of maintaining regular sleep habits and reducing screen exposure. Future studies can be conducted on a larger population and may include clinical tests for more accurate assessment. Further research can also explore other factors affecting dry eye symptoms. In conclusion, this study shows that circadian chronotype and sleep quality are important factors influencing dry eye symptoms among university students. Adopting healthy lifestyle habits may help in reducing the risk of dry eye and improving overall well-being. SUGGESTIONS AND RECOMMENDATIONS Based on the findings of the present study, the following suggestions and recommendations are proposed to reduce dry eye symptoms and improve sleep quality among university students. Circadian-Friendly Campus Environment Universities can promote schedules and activities that align with students’ natural biological rhythms. Encouraging exposure to natural light and reducing late-night academic pressure may help maintain a balanced circadian cycle. Digital Eye Health Tracker Application Development of a mobile application for students that can monitor screen time, provide reminders for blinking and taking breaks, and track sleep patterns to promote healthier digital habits. Smart Study Break Zones Establishment of designated areas within campuses where students can rest their eyes. These spaces may include low-light environments, greenery, and minimal screen exposure to reduce visual strain. Chronotype-Based Academic Planning Students can be guided to plan their academic activities according to their individual chronotype, allowing them to study during their peak performance periods. Blue Light Awareness Programs Awareness campaigns can be conducted to educate students about the effects of blue light exposure. Promotion of night mode, screen filters, and protective measures can help reduce eye strain. Digital Detox Initiatives Universities can introduce initiatives encouraging students to reduce screen use for certain periods, such as designated low-screen days, to minimize continuous eye exposure. Inclusion in Student Orientation Programs Eye health and sleep hygiene education can be included in orientation sessions to help students develop healthy habits from the beginning of their academic life. Interdisciplinary Collaboration Collaboration between public health professionals, ophthalmologists, and psychologists can help in organizing awareness programs, screening activities, and further research. Use of Wearable Devices for Sleep Monitoring Encouraging students to use wearable devices such as smartwatches to monitor sleep patterns and improve awareness about sleep quality. Promotion of Healthy Night Routine Students should be encouraged to reduce screen exposure before bedtime, follow eye relaxation practices, and maintain proper lighting conditions to improve sleep and eye health. Innovative strategies such as the development of digital eye health applications, creation of circadian-friendly campuses, and implementation of digital detox initiatives may further enhance eye health promotion among university students. Declarations Ethical approval for this study was obtained from the Institutional Ethics Committee of Dr. Giri Lal Gupta Institute of Public Health & Public Affairs, University of Lucknow. The study adhered to the principles of the Declaration of Helsinki. Informed consent was obtained from all participants prior to their inclusion in the study. Author Contribution Shalini Choudhury conceptualized and designed the study, conducted data collection, performed data analysis and interpretation, carried out the literature review, and drafted as well as revised the manuscript. The author read and approved the final version of the manuscript. Acknowledgement ACNOWLEDGEMENTI would like to express my profound sense of gratitude and sincere respect to my esteemed guide, Dr. Tanaya Srivastava, for her invaluable guidance, scholarly insight, and unwavering support throughout the course of this research. Her depth of knowledge, patience, and thoughtful mentorship have been instrumental in shaping the direction and quality of this dissertation. Her ability to provide clarity during challenging phases and her constant motivation to strive for academic excellence have left a lasting impression on my learning journey.I extend my sincere gratitude to Dr. (Prof) P. K. Gupta, Director, Dr. Giri Lal Gupta Institute of Public Health & Public Affairs, University of Lucknow, for his leadership and support, which created a conducive academic environment for this research.I take this opportunity to extend my heartfelt appreciation to Dr. Shipra Bhardwaj, faculty member, Dr. Giri Lal Gupta Institute of Public Health & Public Affairs, University of Lucknow, for her continuous assistance, constructive feedback, and readiness to guide me whenever needed. I feel deeply honored to acknowledge Dr. Anjali, faculty member, Dr. Giri Lal Gupta Institute of Public Health & Public Affairs, University of Lucknow, whose guidance, inspiration, and positive outlook have been a constant source of strength. Her belief in my abilities and her thoughtful advice helped me remain focused, determined, and committed throughout the research process. I would also like to express my sincere thanks to Dr. Maitri Bajpai, faculty member, Dr. Giri Lal Gupta Institute of Public Health & Public Affairs, University of Lucknow, for her kind support, insightful suggestions, and reassuring guidance, especially during critical phases of this study.I owe my deepest gratitude to my beloved parents, whose unconditional love, endless sacrifices, and unwavering faith in me have been the cornerstone of my life. Their constant prayers, emotional support, and belief in my potential have given me the strength to overcome challenges and move forward with confidence. This accomplishment is as much theirs as it is mine.I would like to express my heartfelt gratitude to my husband, Lakshay Taneja, for his constant support, encouragement, patience, and understanding throughout this journey. His unwavering belief in me and his presence during challenging times have been a source of strength and motivation.I am equally grateful to my dear friends and loved ones, whose understanding, companionship, and moral support made this journey more meaningful and less overwhelming. Their presence, whether through words of reassurance or silent support, has played a vital role in keeping me motivated and positive.I would also like to acknowledge with appreciation all those individuals who, directly or indirectly, contributed to the completion of this work. Their support, cooperation, and goodwill have been invaluable and deeply appreciated.Finally, with utmost humility and reverence, I express my heartfelt gratitude to the Almighty for His divine blessings, strength, and guidance. His grace has illuminated my path, given me resilience in difficult times, and enabled me to successfully accomplish this milestone in my academic journey. References Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: A comprehensive review. Chronobiol Int. 2012;29(9):1153–75. Asiedu K, Dzasimatu SK, Kyei S. Prevalence and characteristics of dry eye disease among university students. Clin Optometry. 2017;9:107–14. Ayaki M, Kawashima M, Negishi K, Tsubota K. Sleep and mood disorders in dry eye disease. Sci Rep. 2018;8(1):1–7. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276–83. Kawashima M, Uchino M, Yokoi N, et al. Sleep quality and dry eye disease. Investig Ophthalmol Vis Sci. 2016;57(4):2051–8. Li S, et al. Relationship between circadian typology and dry eye symptoms in college students. BMC Ophthalmol. 2022;22:1–10. Lin PY, Tsai SY, Cheng CY, et al. Association between sleep quality and dry eye syndrome. J Clin Med. 2019;8(8):1–10. Moon JH, Lee MY, Moon NJ. Association between smartphone use and dry eye disease. BMC Ophthalmol. 2014;14:1–6. Randler C. Chronotype and daily functioning. Biol Rhythm Res. 2014;45(3):1–10. Sharma A, et al. Sleep quality among college students in India. Indian J Public Health Res. 2021;12(2):45–50. Stapleton F, Alves M, Bunya VY, et al. Epidemiology of dry eye disease. Ocul Surf. 2017;15(3):334–65. Uchino M, Schaumberg DA. Dry eye disease: Impact and lifestyle factors. BMJ Open. 2013;3(3):1–6. Wang J, et al. Chronotype and sleep patterns in students. Sleep Med. 2022;90:1–7. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276–83. Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15(3):334–65. Uchino M, Schaumberg DA. Dry eye disease: Impact of environmental and lifestyle factors. Curr Opin Ophthalmol. 2013;24(4):259–64. Asiedu K, Kyei S, Boampong F, Ocansey S. Symptomatic dry eye and its associated factors among university students. Eye Contact Lens. 2017;43(4):262–6. Ayaki M, Kawashima M, Negishi K, Tsubota K, Kawashima S. Sleep and mood disorders in dry eye disease. Sci Rep. 2018;8:1–7. Kawashima M, Uchino M, Yokoi N, Uchino Y, Dogru M, Komuro A, Sonomura Y, Kato H, Tsubota K, Kawashima S. Associations between dry eye disease and sleep quality. Am J Ophthalmol. 2016;169:106–11. Potter GDM, Skene DJ, Arendt J, Cade JE, Grant PJ, Hardie LJ. Circadian rhythm and sleep regulation. Lancet. 2016;388(10057):2442–52. Logan RW, McClung CA. Circadian rhythms and mental health. Nat Rev Neurosci. 2019;20(1):1–15. Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: A comprehensive review. Chronobiol Int. 2012;29(9):1153–75. Horne JA, Östberg O. A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. Int J Chronobiology. 1976;4(2):97–110. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 May, 2026 Editor assigned by journal 13 May, 2026 Submission checks completed at journal 13 May, 2026 First submitted to journal 05 May, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9615333","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635368683,"identity":"bc05f25d-c905-4870-94f0-87fa29a5ed7f","order_by":0,"name":"Shalini Choudhury","email":"data:image/png;base64,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","orcid":"","institution":"University of Lucknow","correspondingAuthor":true,"prefix":"","firstName":"Shalini","middleName":"","lastName":"Choudhury","suffix":""}],"badges":[],"createdAt":"2026-05-05 07:39:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9615333/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9615333/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108841249,"identity":"7575cc0f-715d-4cbf-b93e-5de1f2007364","added_by":"auto","created_at":"2026-05-09 01:07:44","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20188,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph showing distribution of dry eye symptoms among partic\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/9791ddbc604eabf1782f2a2b.jpeg"},{"id":108841250,"identity":"a3d71303-bfce-45f4-ae6d-d308ff536adf","added_by":"auto","created_at":"2026-05-09 01:07:44","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19638,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph showing distribution of sleep quality among participants.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/a6a3451e1a136bf7b7daa9c0.jpeg"},{"id":108841253,"identity":"fcec2f70-b437-4730-bd4f-cde4aeead781","added_by":"auto","created_at":"2026-05-09 01:07:44","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":13690,"visible":true,"origin":"","legend":"\u003cp\u003ePie chart showing distribution of circadian chronotypes\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/fdbb6d03dee62e3f503298b1.jpeg"},{"id":108841251,"identity":"48524cfc-0bdc-4a83-84d3-bb5985a76990","added_by":"auto","created_at":"2026-05-09 01:07:44","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":19349,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph showing association between chronotype and dry eye symptoms.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/b0247b65fc5d8466e80a6a22.jpeg"},{"id":108977181,"identity":"b4fa31cd-d56d-42ce-8577-e3db5ace6cae","added_by":"auto","created_at":"2026-05-11 11:30:45","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":19660,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph showing association between sleep quality and dry eye symptoms.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/fef79cc0b1b930648331ceb3.jpeg"},{"id":108977068,"identity":"ea8c1105-00ca-49e1-ac36-9caa805c67dc","added_by":"auto","created_at":"2026-05-11 11:30:13","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":20947,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph showing comparison of mean OSDI and PSQI scores among different chronotype groups.\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/99f5a5ada53bc62c7fb13877.jpeg"},{"id":108979600,"identity":"a16cd852-c051-46fa-ad25-a3e77abf9869","added_by":"auto","created_at":"2026-05-11 12:00:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":429048,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9615333/v1/3ff403b4-6496-4276-8f6c-cae9bfe47510.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Circadian Chronotype and Dry Eye Symptoms Among University Students- A Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDry eye disease is a multifactorial disorder of the ocular surface characterized by instability of the tear film and associated symptoms such as dryness, irritation, foreign body sensation, photophobia, and blurred vision. These symptoms can significantly interfere with daily activities and negatively impact quality of life (Craig et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In recent years, dry eye has emerged as a growing public health concern due to its increasing prevalence and its effect on functional and visual performance, especially among young adults.\u003c/p\u003e \u003cp\u003eThe global burden of dry eye disease has been increasing steadily, with studies reporting a high prevalence across different populations (Stapleton et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Although traditionally considered a condition affecting older individuals, recent evidence indicates that dry eye symptoms are becoming increasingly common among university students. This rise can be attributed to lifestyle-related factors such as prolonged use of digital devices, irregular sleep schedules, academic stress, and reduced outdoor exposure (Uchino \u0026amp; Schaumberg, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Previous studies have reported a considerable prevalence of symptomatic dry eye among students, emphasizing the importance of addressing this issue in this population (Asiedu et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLifestyle and behavioral factors play a significant role in the development and progression of dry eye symptoms. Among these, sleep quality has been identified as an important contributing factor. Poor sleep can disrupt normal physiological processes, leading to increased ocular discomfort and tear film instability (Ayaki et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Furthermore, dry eye symptoms may themselves contribute to sleep disturbances, suggesting a bidirectional relationship between sleep quality and ocular surface health (Kawashima et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This interaction highlights the role of underlying biological systems regulating daily physiological rhythms.\u003c/p\u003e \u003cp\u003eCircadian rhythms are endogenous biological processes that follow a roughly 24-hour cycle and regulate essential functions such as sleep\u0026ndash;wake patterns, hormonal secretion, and metabolic activity (Potter et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). These rhythms are critical for maintaining physiological balance. Disruptions in circadian rhythms have been associated with various health problems, including sleep disorders, psychological conditions, and chronic diseases (Logan \u0026amp; McClung, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Increasing attention has been given to the role of circadian rhythms in influencing different aspects of health, including ocular conditions.\u003c/p\u003e \u003cp\u003eCircadian chronotype refers to an individual\u0026rsquo;s natural preference for the timing of sleep and daily activities, reflecting variations in circadian rhythms (Adan et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Based on these preferences, individuals are commonly categorized into morning type (M-type), evening type (E-type), and intermediate type (N-type) (Horne \u0026amp; \u0026Ouml;stberg, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e1976\u003c/span\u003e). Morning-type individuals tend to be more alert and active earlier in the day, whereas evening-type individuals show peak performance later in the day and often experience difficulty waking up early. Intermediate types exhibit characteristics between these two extremes.\u003c/p\u003e \u003cp\u003eDifferences in chronotype are known to influence sleep behavior, lifestyle patterns, and overall health outcomes. Among university students, evening-type individuals are more likely to have irregular sleep patterns, increased screen exposure, and higher stress levels compared to morning-type individuals (Adan et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These factors may increase the likelihood of experiencing dry eye symptoms. However, despite growing evidence linking circadian rhythms to health outcomes, limited research has explored the association between circadian chronotype and dry eye symptoms, particularly among university students.\u003c/p\u003e \u003cp\u003eUnderstanding this relationship is important for identifying modifiable risk factors and developing preventive strategies. By examining the association between circadian chronotype and dry eye symptoms, it may be possible to promote healthier sleep patterns and lifestyle behaviors among students, thereby reducing the burden of dry eye and improving overall well-being.\u003c/p\u003e \u003cp\u003eTherefore, the present study was undertaken to assess the association between circadian chronotype and dry eye symptoms among university students using a cross-sectional study design.\u003c/p\u003e"},{"header":"SIGNIFICANCE OF THE STUDY","content":"\u003cp\u003eDry eye symptoms are increasingly being observed among university students due to rapid changes in lifestyle. Factors such as prolonged use of mobile phones and computers, reduced blinking during screen use, irregular sleep schedules, and academic stress contribute to eye discomfort and dryness. Despite this growing problem, many students remain unaware of the causes and preventive measures. Therefore, studying dry eye in this population is important from both a clinical and public health perspective.\u003c/p\u003e \u003cp\u003eIn recent years, attention has shifted toward understanding how biological factors influence health conditions. One such factor is circadian chronotype, which refers to an individual\u0026rsquo;s natural preference for sleep and activity timing. Some individuals function better in the morning, while others are more active at night. These differences in daily rhythm can affect sleep quality, lifestyle habits, and overall health. However, the role of circadian chronotype in relation to dry eye symptoms has not been widely studied, especially among university students.\u003c/p\u003e \u003cp\u003eThis study is significant because it explores the connection between circadian chronotype and dry eye symptoms. Students with an evening preference often tend to stay awake late at night, use digital devices for longer durations, and have irregular sleep patterns. These habits may increase the risk of developing dry eye symptoms. By identifying such associations, this study helps in understanding which group of students may be more vulnerable.\u003c/p\u003e \u003cp\u003eThe findings of this study can be useful in developing simple and practical preventive strategies. Creating awareness about maintaining proper sleep habits, limiting excessive screen time, and following a balanced daily routine can help reduce the occurrence of dry eye symptoms. Early identification and lifestyle modification can prevent worsening of symptoms and improve students\u0026rsquo; comfort and productivity.\u003c/p\u003e \u003cp\u003eIn addition, this study has importance in the field of public health as it highlights the need to consider lifestyle and biological rhythms together while addressing health problems. It also adds to the existing knowledge by linking circadian patterns with ocular health. The results may serve as a reference for future research and can help healthcare professionals design targeted interventions for student populations.\u003c/p\u003e \u003cp\u003eOverall, this study not only focuses on understanding the problem but also provides a basis for prevention and awareness, which can ultimately improve both eye health and overall quality of life among university students.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOBJECTIVES OF THE STUDY\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eGeneral Objective\u003c/h2\u003e \u003cp\u003eTo investigate the association between circadian chronotype and dry eye symptoms among university students.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSpecific Objectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo determine the prevalence of dry eye symptoms among university students.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo categorize participants into circadian chronotypes (morning, intermediate, and evening types).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess sleep quality among the study participants.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo compare dry eye symptom severity across different chronotype groups.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo evaluate the relationship between sleep quality and dry eye symptoms.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"REVIEW OF LITERATURE","content":"\u003cp\u003e \u003cb\u003eCraig, J. P., et al. (2017).\u003c/b\u003e Craig and colleagues provided a comprehensive definition and classification of dry eye disease under the TFOS DEWS II report. The study highlighted that dry eye is a multifactorial disease involving tear film instability, inflammation, and neurosensory abnormalities. The authors emphasized that dry eye significantly affects visual function and quality of life. This study serves as a foundational reference for understanding the clinical aspects of dry eye disease.\u003c/p\u003e \u003cp\u003eStapleton, F., et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Stapleton and colleagues conducted a global epidemiological analysis of dry eye disease. Their findings indicated that dry eye prevalence varies widely across populations, with increasing incidence among younger individuals due to lifestyle factors. The study highlighted environmental exposure, digital screen use, and behavioral habits as key contributors. This research establishes dry eye as an emerging public health issue.\u003c/p\u003e \u003cp\u003eAsiedu, K., et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Asiedu and colleagues investigated the prevalence of dry eye symptoms among university students. The study included 650 participants and used the OSDI questionnaire for assessment. The results showed a high prevalence of symptomatic dry eye among students, mainly associated with prolonged screen use and reduced blinking. This study highlights the vulnerability of student populations to dry eye symptoms.\u003c/p\u003e \u003cp\u003e \u003cb\u003eUchino, M., \u0026amp; Schaumberg, D. A. (2013).\u003c/b\u003e Uchino and Schaumberg examined the role of environmental and lifestyle factors in dry eye disease. The study found that increased screen time, low humidity environments, and poor lifestyle habits significantly contribute to dry eye symptoms. The authors concluded that behavioral modifications are essential for prevention. This study supports the importance of lifestyle in ocular health.\u003c/p\u003e \u003cp\u003eAyaki, M., et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Ayaki and colleagues explored the relationship between sleep quality and dry eye disease. Using standardized questionnaires, they found that individuals with poor sleep quality reported more severe dry eye symptoms. The study also highlighted the presence of mood disturbances among affected individuals. This research suggests a strong link between sleep and ocular surface health.\u003c/p\u003e \u003cp\u003eKawashima, M., et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Kawashima and colleagues conducted a study to evaluate the association between dry eye disease and sleep quality. The results showed that individuals with dry eye had significantly poorer sleep quality compared to healthy individuals. The study suggested a bidirectional relationship between sleep disturbances and dry eye symptoms. This finding emphasizes the role of sleep in eye health.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePotter, G. D., et al. (2016).\u003c/b\u003e Potter and colleagues discussed the importance of circadian rhythms in regulating human physiological processes. The study highlighted that circadian rhythms influence sleep, hormone secretion, and metabolic activity. Disruption in these rhythms was linked to various health conditions. This research provides a biological basis for studying circadian influences on health.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLogan, R. W., \u0026amp; McClung, C. A. (2019).\u003c/b\u003e Logan and McClung reviewed the impact of circadian rhythm disturbances on mental and physical health. The study found that disruptions in circadian timing are associated with sleep disorders, depression, and chronic diseases. The authors emphasized the importance of maintaining circadian balance. This study supports the broader health implications of circadian rhythms.\u003c/p\u003e \u003cp\u003eAdan, A., et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Adan and colleagues conducted a comprehensive review on circadian chronotype. The study explained that individuals differ in their sleep\u0026ndash;wake preferences and classified them into morning, evening, and intermediate types. The authors highlighted that chronotype influences behavior, sleep patterns, and health outcomes. This study provides a conceptual understanding of chronotype.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHorne, J. A., \u0026amp; \u0026Ouml;stberg, O. (1976).\u003c/b\u003e Horne and \u0026Ouml;stberg developed the Morningness\u0026ndash;Eveningness Questionnaire (MEQ) to assess circadian chronotype. The tool is widely used to classify individuals based on their sleep preferences. The study established a scientific method for identifying chronotype categories. This questionnaire is essential for chronotype-related research.\u003c/p\u003e \u003cp\u003eWang, J., et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Wang and colleagues examined the association between chronotype and sleep patterns among university students. The study found that evening-type individuals had poorer sleep quality, higher stress levels, and irregular daily routines. The authors concluded that chronotype plays a significant role in student health. This study highlights the behavioral impact of chronotype.\u003c/p\u003e \u003cp\u003eLi, S., et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Li and colleagues investigated the relationship between circadian typology and dry eye symptoms among college students. The study found that evening-type individuals had more severe dry eye symptoms and poorer sleep quality compared to morning-type individuals. The authors concluded that circadian chronotype is an important factor influencing dry eye severity. This study closely relates to the present research topic.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGupta, N., et al. (2019).\u003c/b\u003e Gupta and colleagues conducted a study in North India to assess the prevalence of dry eye disease and its associated risk factors. The study found that a significant proportion of young adults reported symptoms of dryness, irritation, and visual discomfort. Prolonged screen exposure and environmental conditions were identified as major contributing factors. The authors emphasized the need for awareness and preventive strategies, especially among younger populations.\u003c/p\u003e \u003cp\u003e \u003cb\u003eVellakkal, S., et al. (2018).\u003c/b\u003e Vellakkal and colleagues examined the impact of lifestyle behaviors on sleep quality among Indian adults. The study reported that irregular sleep patterns and increased screen time were associated with poor sleep quality. Participants with disturbed sleep also reported higher levels of fatigue and reduced daily functioning. This study highlights the importance of sleep in maintaining overall health.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMalik, R., et al. (2020).\u003c/b\u003e Malik and colleagues studied the prevalence of digital eye strain among university students in India. The findings showed that a large number of students experienced symptoms such as dryness, eye strain, and blurred vision due to excessive screen use. The study concluded that digital habits significantly contribute to ocular discomfort among students.\u003c/p\u003e \u003cp\u003eSharma, A., et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Sharma and colleagues investigated sleep quality and its associated factors among college students in India. The study revealed that a majority of students had poor sleep quality, mainly due to irregular routines and academic stress. The authors found that poor sleep was associated with reduced concentration and increased health complaints. This study supports the importance of sleep behavior in student health.\u003c/p\u003e \u003cp\u003e \u003cb\u003eKaur, K., et al. (2022).\u003c/b\u003e Kaur and colleagues explored the relationship between lifestyle factors and eye health among young adults in India. The study found that increased screen exposure, poor sleep habits, and lack of awareness contributed to higher prevalence of dry eye symptoms. The authors recommended lifestyle modifications and awareness programs to reduce the burden of dry eye.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTiwari, S., et al. (2020).\u003c/b\u003e Tiwari and colleagues conducted a study among university students in India to assess the prevalence of dry eye symptoms and associated factors. The study found that a considerable number of students reported dryness, irritation, and eye strain. Increased screen time and irregular sleep patterns were identified as significant contributors. The authors concluded that lifestyle factors play a major role in the development of dry eye symptoms among students.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAgarwal, R., et al. (2019).\u003c/b\u003e Agarwal and colleagues examined digital eye strain and its association with dry eye symptoms among college students in India. The findings showed that prolonged use of smartphones and laptops was significantly associated with increased dry eye symptoms. The study also reported that students with poor sleep habits experienced more severe symptoms. This study highlights the combined effect of screen exposure and sleep on eye health.\u003c/p\u003e \u003cp\u003e \u003cb\u003eChaudhary, V., et al. (2021).\u003c/b\u003e Chaudhary and colleagues investigated sleep quality and its impact on health among university students in India. The study found that poor sleep quality was common among students and was associated with fatigue, reduced concentration, and physical discomfort, including eye-related symptoms. The authors emphasized the importance of maintaining regular sleep patterns for overall health.\u003c/p\u003e \u003cp\u003e \u003cb\u003eVerma, S., et al. (2022).\u003c/b\u003e Verma and colleagues studied the relationship between lifestyle habits and ocular symptoms among young adults in India. The study revealed that students with irregular daily routines, late-night activities, and excessive screen use were more likely to report symptoms of dry eye. The authors suggested that behavioral modifications could help reduce these symptoms.\u003c/p\u003e"},{"header":"RESEARCH METHODOLOGY","content":"\u003ch3\u003e\u003cstrong\u003ePlace of Study\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe present study was conducted among university students of Lucknow, Uttar Pradesh. Participants were selected from different departments to ensure representation of diverse academic backgrounds.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eA \u003cstrong\u003ecross-sectional study design\u003c/strong\u003e was adopted to assess the association between circadian chronotype and dry eye symptoms among university students.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eStudy Period\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study was carried out over a period of \u003cstrong\u003e2\u0026ndash;3 months\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study population included undergraduate and postgraduate students enrolled in the university. Students who were willing to participate and provided informed consent were included in the study.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eArea of Study\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study was conducted within the university campus, including classrooms, hostels, and common student areas.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eSample\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eA total of \u003cstrong\u003e200 university students\u003c/strong\u003e were included in the study.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eSampling Technique\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eA \u003cstrong\u003econvenience sampling technique\u003c/strong\u003e was used to select participants based on their availability and willingness to participate.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003ch3\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe sample size for the study was \u003cstrong\u003e200 participants\u003c/strong\u003e, which was considered adequate to assess the relationship between circadian chronotype and dry eye symptoms in the selected population.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003eStudents aged 18 years and above\u003c/li\u003e\n \u003cli\u003eStudents currently enrolled in the university\u003c/li\u003e\n \u003cli\u003eStudents willing to participate and provide consent\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003eStudents with known ocular diseases other than dry eye\u003c/li\u003e\n \u003cli\u003eStudents using ocular medications\u003c/li\u003e\n \u003cli\u003eStudents with systemic diseases affecting the eye\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\u003cstrong\u003eStudy Tools Used in Data Collection\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eData were collected using standardized and validated questionnaires:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eOcular Surface Disease Index (OSDI):\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Used to assess the severity of dry eye symptoms.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMorningness\u0026ndash;Eveningness Questionnaire (MEQ):\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Used to determine circadian chronotype (morning, intermediate, evening).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePittsburgh Sleep Quality Index (PSQI):\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Used to evaluate sleep quality among participants.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003e\u003cstrong\u003eData Collection Procedure\u003c/strong\u003e\u003c/h3\u003e\n\u003ch4\u003e\u003cstrong\u003eStage 1: Formulation of Questionnaire\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eA structured questionnaire was prepared incorporating OSDI, MEQ, and PSQI along with basic demographic details.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eCollection of Required Information\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eParticipants were informed about the purpose of the study, and consent was obtained prior to data collection.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eCollection of Data\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eData were collected through self-administered questionnaires. Participants completed the forms in the presence of the researcher to ensure accuracy.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTechniques Used in Data Analysis\u003c/strong\u003e\u003c/h3\u003e\n\u003ch4\u003e\u003cstrong\u003eStage 2: Interpretation of Data\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eCollected data were checked for completeness and entered into a spreadsheet for analysis.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/h4\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eData were analyzed using appropriate statistical methods.\u003c/li\u003e\n \u003cli\u003eDescriptive statistics (mean, percentage) were used to summarize data.\u003c/li\u003e\n \u003cli\u003eChi-square test was applied to assess association between variables.\u003c/li\u003e\n \u003cli\u003eANOVA test was used to compare mean scores among different chronotype groups.\u003c/li\u003e\n \u003cli\u003eA \u003cstrong\u003ep-value \u0026lt; 0.05\u003c/strong\u003e was considered statistically significant.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003eInformed consent was obtained from all participants.\u003c/li\u003e\n \u003cli\u003eConfidentiality of participants\u0026rsquo; information was maintained.\u003c/li\u003e\n \u003cli\u003eParticipation was voluntary, and participants were free to withdraw at any time.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eA total of \u003cstrong\u003e200 university students\u003c/strong\u003e participated in the study to assess the association between circadian chronotype, sleep quality, and dry eye symptoms.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of \u003cstrong\u003e200 university students\u003c/strong\u003e participated in the present study to assess the association between circadian chronotype, sleep quality, and dry eye symptoms.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e1. Prevalence of Dry Eye Symptoms\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOut of 200 participants, \u003cstrong\u003e40% (n = 80)\u003c/strong\u003e were found to have significant dry eye symptoms, while \u003cstrong\u003e60% (n = 120)\u003c/strong\u003e did not report symptoms.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 1: Distribution of Dry Eye Symptoms\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cstrong\u003e2. Sleep Quality of Participants\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOut of the total participants, 53% (n = 106) had poor sleep quality, whereas 47% (n = 94) had good sleep quality.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 2: Distribution of Sleep Quality\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e53%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3. Distribution of Circadian Chronotype\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were classified into three chronotypes based on MEQ scores. The majority belonged to the intermediate type.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMorning type: 30% (n = 60)\u003c/li\u003e\n \u003cli\u003eIntermediate type: 45% (n = 90)\u003c/li\u003e\n \u003cli\u003eEvening type: 25% (n = 50)\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 3: Distribution of Circadian Chronotype\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronotype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMorning (M-type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eIntermediate (N-type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEvening (E-type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4. Association Between Chronotype and Dry Eye\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant association was observed between circadian chronotype and dry eye symptoms (p \u0026lt; 0.001). Evening-type participants showed the highest prevalence of dry eye symptoms.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 4: Association Between Chronotype and Dry Eye Symptoms\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8232%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronotype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry Eye Present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry Eye Absent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2236%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8232%;\"\u003e\n \u003cp\u003eM-type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2236%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8232%;\"\u003e\n \u003cp\u003eN-type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2236%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8232%;\"\u003e\n \u003cp\u003eE-type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2236%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.8232%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.4766%;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2236%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cstrong\u003e5. Sleep Quality and Dry Eye Symptoms\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eParticipants with poor sleep quality were more likely to experience dry eye symptoms. This association was statistically significant (\u003cstrong\u003ep \u0026lt; 0.001\u003c/strong\u003e).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 5: Association Between Sleep Quality and Dry Eye\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry Eye Present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry Eye Absent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cstrong\u003e6. Comparison of Scores Among Chronotype Groups\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe mean \u003cstrong\u003eOcular Surface Disease Index (OSDI)\u003c/strong\u003e scores and \u003cstrong\u003ePittsburgh Sleep Quality Index (PSQI)\u003c/strong\u003e scores varied significantly among different chronotype groups. Evening-type participants had the highest scores, indicating more severe dry eye symptoms and poorer sleep quality, while morning-type participants had the lowest scores.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable6: Mean Ocular Surface Disease Index (OSDI) and Pittsburgh Sleep Quality Index (PSQI) Scores by Chronotype\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronotype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean OSDI Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean PSQI Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eMorning Type (M-type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eIntermediate Type (N-type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003eEvening Type (E-type)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.3333%;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cstrong\u003e7. Other Factors\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNo significant association was observed between gender and dry eye symptoms. Similarly, awareness regarding dry eye did not show any significant relationship.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study was carried out to understand the relationship between circadian chronotype, sleep quality, and dry eye symptoms among university students. The findings of this study help explain how lifestyle and daily routines can affect eye health.\u003c/p\u003e \u003cp\u003eIn this study, \u003cb\u003e40% of students were found to have dry eye symptoms\u003c/b\u003e. This result is similar to the study by Asiedu et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), which also reported a high number of students experiencing dry eye. This shows that dry eye is becoming common among students, mainly due to increased screen use and academic pressure.\u003c/p\u003e \u003cp\u003eThe study also found that \u003cb\u003e53% of students had poor sleep quality\u003c/b\u003e. This finding is supported by Sharma et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, who reported that many college students have disturbed sleep due to irregular schedules and stress. Poor sleep is a common issue among students today.\u003c/p\u003e \u003cp\u003eA strong relationship was found between \u003cb\u003esleep quality and dry eye symptoms\u003c/b\u003e in this study (\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e). Students with poor sleep were more likely to have dry eye symptoms. This finding agrees with studies by Ayaki et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and Kawashima et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), which also showed that sleep problems are linked with eye discomfort. This means that sleep plays an important role in maintaining eye health.\u003c/p\u003e \u003cp\u003eWhen looking at circadian chronotype, the study showed that \u003cb\u003eevening-type students had the highest dry eye symptoms\u003c/b\u003e, while \u003cb\u003emorning-type students had the lowest\u003c/b\u003e. This finding is similar to the study by Li et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, which also found that evening-type individuals had more severe symptoms and poorer sleep. This suggests that students who stay awake late and follow irregular routines are more likely to develop dry eyes.\u003c/p\u003e \u003cp\u003eThe study also showed that \u003cb\u003eOSDI (Ocular Surface Disease Index) and PSQI (Pittsburgh Sleep Quality Index) scores were highest in evening-type students\u003c/b\u003e, which means they had worse eye symptoms and poorer sleep. Similar findings were reported by Wang et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, where evening-type individuals had poorer health outcomes.\u003c/p\u003e \u003cp\u003eOne possible reason for this is that evening-type students often use screens late at night, sleep late, and do not follow a fixed routine. These habits can reduce tear production and increase eye strain, leading to dry eye symptoms. On the other hand, morning-type students usually have better sleep habits and more regular routines, which may help protect their eye health.\u003c/p\u003e \u003cp\u003eThe study also found that \u003cb\u003egender and awareness about dry eye were not significantly related\u003c/b\u003e to dry eye symptoms. This suggests that lifestyle factors like sleep and daily habits may be more important than personal characteristics.\u003c/p\u003e \u003cp\u003eOverall, the findings of this study are similar to previous research and show that \u003cb\u003esleep quality and circadian chronotype play an important role in dry eye symptoms\u003c/b\u003e. This highlights the need to improve sleep habits, reduce screen time, and maintain a regular routine to prevent dry eye problems among students.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe present study was conducted to assess the association between circadian chronotype, sleep quality, and dry eye symptoms among university students. The findings of the study show that dry eye symptoms are quite common among students and are closely related to lifestyle factors.\u003c/p\u003e\n\u003cp\u003eThe study found that students with an evening chronotype were more likely to experience dry eye symptoms and poor sleep quality compared to those with a morning chronotype. This indicates that irregular daily routines and late-night activities may increase the risk of eye discomfort. In contrast, students with a morning preference showed better sleep patterns and fewer dry eye symptoms.\u003c/p\u003e\n\u003cp\u003eThe results of this study are in line with previous research, which also suggests that sleep quality and circadian rhythm play an important role in eye health. This shows that the findings are reliable and supported by earlier studies.\u003c/p\u003e\n\u003cp\u003eThe findings of this study can be applied to similar student populations, especially those with similar lifestyles and academic pressures. However, the study has some limitations. The data were collected using self-reported questionnaires, which may include personal bias. Also, the study was limited to a specific group of students and may not represent all populations.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the study provides useful information about the role of circadian chronotype and sleep in dry eye symptoms. It highlights the importance of maintaining regular sleep habits and reducing screen exposure.\u003c/p\u003e\n\u003cp\u003eFuture studies can be conducted on a larger population and may include clinical tests for more accurate assessment. Further research can also explore other factors affecting dry eye symptoms.\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study shows that circadian chronotype and sleep quality are important factors influencing dry eye symptoms among university students. Adopting healthy lifestyle habits may help in reducing the risk of dry eye and improving overall well-being.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eSUGGESTIONS AND RECOMMENDATIONS\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eBased on the findings of the present study, the following suggestions and recommendations are proposed to reduce dry eye symptoms and improve sleep quality among university students.\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eCircadian-Friendly Campus Environment\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Universities can promote schedules and activities that align with students\u0026rsquo; natural biological rhythms. Encouraging exposure to natural light and reducing late-night academic pressure may help maintain a balanced circadian cycle.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDigital Eye Health Tracker Application\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Development of a mobile application for students that can monitor screen time, provide reminders for blinking and taking breaks, and track sleep patterns to promote healthier digital habits.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSmart Study Break Zones\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Establishment of designated areas within campuses where students can rest their eyes. These spaces may include low-light environments, greenery, and minimal screen exposure to reduce visual strain.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eChronotype-Based Academic Planning\u003c/strong\u003e\u003cbr\u003e\u0026nbsp; Students can be guided to plan their academic activities according to their individual chronotype, allowing them to study during their peak performance periods.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBlue Light Awareness Programs\u003c/strong\u003e\u003cbr\u003e\u0026nbsp; Awareness campaigns can be conducted to educate students about the effects of blue light exposure. Promotion of night mode, screen filters, and protective measures can help reduce eye strain.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDigital Detox Initiatives\u003c/strong\u003e\u003cbr\u003e\u0026nbsp; Universities can introduce initiatives encouraging students to reduce screen use for certain periods, such as designated low-screen days, to minimize continuous eye exposure.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInclusion in Student Orientation Programs\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Eye health and sleep hygiene education can be included in orientation sessions to help students develop healthy habits from the beginning of their academic life.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInterdisciplinary Collaboration\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Collaboration between public health professionals, ophthalmologists, and psychologists can help in organizing awareness programs, screening activities, and further research.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUse of Wearable Devices for Sleep Monitoring\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Encouraging students to use wearable devices such as smartwatches to monitor sleep patterns and improve awareness about sleep quality.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePromotion of Healthy Night Routine\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e Students should be encouraged to reduce screen exposure before bedtime, follow eye relaxation practices, and maintain proper lighting conditions to improve sleep and eye health.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eInnovative strategies such as the development of digital eye health applications, creation of circadian-friendly campuses, and implementation of digital detox initiatives may further enhance eye health promotion among university students.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval for this study was obtained from the Institutional Ethics Committee of Dr. Giri Lal Gupta Institute of Public Health \u0026amp; Public Affairs, University of Lucknow. The study adhered to the principles of the Declaration of Helsinki. Informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eShalini Choudhury conceptualized and designed the study, conducted data collection, performed data analysis and interpretation, carried out the literature review, and drafted as well as revised the manuscript. The author read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eACNOWLEDGEMENTI would like to express my profound sense of gratitude and sincere respect to my esteemed guide, Dr. Tanaya Srivastava, for her invaluable guidance, scholarly insight, and unwavering support throughout the course of this research. Her depth of knowledge, patience, and thoughtful mentorship have been instrumental in shaping the direction and quality of this dissertation. Her ability to provide clarity during challenging phases and her constant motivation to strive for academic excellence have left a lasting impression on my learning journey.I extend my sincere gratitude to Dr. (Prof) P. K. Gupta, Director, Dr. Giri Lal Gupta Institute of Public Health \u0026amp; Public Affairs, University of Lucknow, for his leadership and support, which created a conducive academic environment for this research.I take this opportunity to extend my heartfelt appreciation to Dr. Shipra Bhardwaj, faculty member, Dr. Giri Lal Gupta Institute of Public Health \u0026amp; Public Affairs, University of Lucknow, for her continuous assistance, constructive feedback, and readiness to guide me whenever needed. I feel deeply honored to acknowledge Dr. Anjali, faculty member, Dr. Giri Lal Gupta Institute of Public Health \u0026amp; Public Affairs, University of Lucknow, whose guidance, inspiration, and positive outlook have been a constant source of strength. Her belief in my abilities and her thoughtful advice helped me remain focused, determined, and committed throughout the research process. I would also like to express my sincere thanks to Dr. Maitri Bajpai, faculty member, Dr. Giri Lal Gupta Institute of Public Health \u0026amp; Public Affairs, University of Lucknow, for her kind support, insightful suggestions, and reassuring guidance, especially during critical phases of this study.I owe my deepest gratitude to my beloved parents, whose unconditional love, endless sacrifices, and unwavering faith in me have been the cornerstone of my life. Their constant prayers, emotional support, and belief in my potential have given me the strength to overcome challenges and move forward with confidence. This accomplishment is as much theirs as it is mine.I would like to express my heartfelt gratitude to my husband, Lakshay Taneja, for his constant support, encouragement, patience, and understanding throughout this journey. His unwavering belief in me and his presence during challenging times have been a source of strength and motivation.I am equally grateful to my dear friends and loved ones, whose understanding, companionship, and moral support made this journey more meaningful and less overwhelming. Their presence, whether through words of reassurance or silent support, has played a vital role in keeping me motivated and positive.I would also like to acknowledge with appreciation all those individuals who, directly or indirectly, contributed to the completion of this work. Their support, cooperation, and goodwill have been invaluable and deeply appreciated.Finally, with utmost humility and reverence, I express my heartfelt gratitude to the Almighty for His divine blessings, strength, and guidance. His grace has illuminated my path, given me resilience in difficult times, and enabled me to successfully accomplish this milestone in my academic journey.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: A comprehensive review. Chronobiol Int. 2012;29(9):1153\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiedu K, Dzasimatu SK, Kyei S. Prevalence and characteristics of dry eye disease among university students. Clin Optometry. 2017;9:107\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyaki M, Kawashima M, Negishi K, Tsubota K. Sleep and mood disorders in dry eye disease. Sci Rep. 2018;8(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCraig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawashima M, Uchino M, Yokoi N, et al. Sleep quality and dry eye disease. Investig Ophthalmol Vis Sci. 2016;57(4):2051\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, et al. Relationship between circadian typology and dry eye symptoms in college students. BMC Ophthalmol. 2022;22:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin PY, Tsai SY, Cheng CY, et al. Association between sleep quality and dry eye syndrome. J Clin Med. 2019;8(8):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoon JH, Lee MY, Moon NJ. Association between smartphone use and dry eye disease. BMC Ophthalmol. 2014;14:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRandler C. Chronotype and daily functioning. Biol Rhythm Res. 2014;45(3):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma A, et al. Sleep quality among college students in India. Indian J Public Health Res. 2021;12(2):45\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStapleton F, Alves M, Bunya VY, et al. Epidemiology of dry eye disease. Ocul Surf. 2017;15(3):334\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUchino M, Schaumberg DA. Dry eye disease: Impact and lifestyle factors. BMJ Open. 2013;3(3):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, et al. Chronotype and sleep patterns in students. Sleep Med. 2022;90:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCraig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15(3):334\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUchino M, Schaumberg DA. Dry eye disease: Impact of environmental and lifestyle factors. Curr Opin Ophthalmol. 2013;24(4):259\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsiedu K, Kyei S, Boampong F, Ocansey S. Symptomatic dry eye and its associated factors among university students. Eye Contact Lens. 2017;43(4):262\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyaki M, Kawashima M, Negishi K, Tsubota K, Kawashima S. Sleep and mood disorders in dry eye disease. Sci Rep. 2018;8:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawashima M, Uchino M, Yokoi N, Uchino Y, Dogru M, Komuro A, Sonomura Y, Kato H, Tsubota K, Kawashima S. Associations between dry eye disease and sleep quality. Am J Ophthalmol. 2016;169:106\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePotter GDM, Skene DJ, Arendt J, Cade JE, Grant PJ, Hardie LJ. Circadian rhythm and sleep regulation. Lancet. 2016;388(10057):2442\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLogan RW, McClung CA. Circadian rhythms and mental health. Nat Rev Neurosci. 2019;20(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: A comprehensive review. Chronobiol Int. 2012;29(9):1153\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorne JA, \u0026Ouml;stberg O. A self-assessment questionnaire to determine morningness\u0026ndash;eveningness in human circadian rhythms. Int J Chronobiology. 1976;4(2):97\u0026ndash;110.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9615333/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9615333/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the link between circadian preferences and dry eye symptoms in a population of university students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted among 200 university students. All participants were assessed using standardized questionnaires, including the Ocular Surface Disease Index (OSDI) to evaluate dry eye symptoms, the Morningness–Eveningness Questionnaire (MEQ) to determine circadian chronotype, and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality.\u003c/p\u003e\n\u003cp\u003eBased on the scores obtained from the MEQ, participants were categorized into three chronotype groups: Evening type (E-type), Intermediate/Neutral type (N-type), and Morning type (M-type). The collected data were then analyzed to examine the relationship between circadian chronotype and the severity of dry eye symptoms among the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 200 university students included in the study, the prevalence of poor sleep quality (PSQI \u0026gt; 5) was found to be 53.0%, while dry eye symptoms (OSDI \u0026gt; 13) were observed in 40.0% of the participants.\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was noted in the distribution of circadian chronotypes across varying levels of dry eye severity (χ² = 59.44, p \u0026lt; 0.001). Students classified as evening type (E-type) exhibited the highest severity of dry eye symptoms compared to neutral type (N-type) and morning type (M-type) individuals.\u003c/p\u003e\n\u003cp\u003eFurthermore, both OSDI scores and PSQI scores showed significant variation across different chronotype groups (F = 22.14, p \u0026lt; 0.001 and F = 15.21, p \u0026lt; 0.001, respectively). The highest mean scores for both indices were observed among E-type participants, followed by N-type, while M-type students demonstrated the lowest scores, indicating comparatively lesser symptom severity and better sleep quality.\u003c/p\u003e\n\u003cp\u003eMultivariate analysis revealed that circadian chronotype was an independent predictor of dry eye symptoms. The likelihood of experiencing dry eye symptoms was significantly higher among E-type individuals, who had approximately 6.9 times greater risk compared to M-type students (p \u0026lt; 0.001). Similarly, N-type individuals showed an increased risk of about 3.2 times relative to the M-type group (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eIn addition, poor sleep quality was identified as an independent risk factor for dry eye symptoms (p \u0026lt; 0.001). However, variables such as gender and awareness regarding dry eye did not show any significant association with the presence of dry eye symptoms in the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of the present study indicate that both the severity of dry eye symptoms and sleep quality are significantly associated with circadian chronotype among university students. Individuals with an evening chronotype (E-type) were more likely to experience poorer sleep quality and increased severity of dry eye symptoms compared to those with intermediate and morning chronotypes. As the circadian preference shifts towards an evening pattern, the likelihood of compromised sleep and aggravated dry eye symptoms appears to increase.\u003c/p\u003e","manuscriptTitle":"Association Between Circadian Chronotype and Dry Eye Symptoms Among University Students- A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-09 01:07:37","doi":"10.21203/rs.3.rs-9615333/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-14T08:16:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-13T04:51:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-13T04:51:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-05-05T07:32:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81eca105-1c29-4808-9931-df4c2f6d5b1d","owner":[],"postedDate":"May 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-14T08:16:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-13T04:51:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-13T04:51:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-05-05T07:32:11+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T16:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-09 01:07:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9615333","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9615333","identity":"rs-9615333","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}