The Impact of a Smartphone Reminder Application on Artificial Tear Adherence in Dry Eye Disease

Background: Dry eye disease (DED) impairs quality of life. Artificial tears are the first-line treatment, but compliance is generally poor. Patients forget to instil drops or underestimate the importance of regular use. Mobile health (mHealth) applications improve adherence in other chronic conditions, but their role in DED remains unclear. This study evaluated the effectiveness of a smartphone reminder application in improving compliance to a four-times-daily artificial tear regimen and the associated symptom relief among patients with DED. Methods: A masked randomised crossover trial was conducted in 29 women with DED (mean ± SD age 21.2 ± 3.0 years). Participants completed two 14-day study phases: one with app-based reminders and one without, separated by a 7-day washout period. The primary outcome was mean daily drop frequency. Secondary outcomes were self-reported symptom frequency and severity assessed using the Symptom Assessment iN Dry Eye (SANDE). Results: The mean daily drop frequency was higher during the app phase compared with the non-app phase (F = 22.906, p < 0.001) but declined in both phases over time (F = 3.023, p < 0.001). Symptom frequency did not differ between phases but decreased over time (F = 1.993, p = 0.021). Symptom severity remained unchanged with no significant effects by phase or time. Baseline clinical measures did not predict drop use frequency or app-related improvement (p > 0.05). Conclusions: The reminder application increased short-term compliance to artificial tear use, but there was no corresponding reduction in symptoms or signs over two weeks' usage. Compliance waned over time despite active reminders, suggesting that prompts alone are insufficient for sustaining behaviour change. Future digital interventions for DED should incorporate strategies to enhance motivation, support long-term engagement, and provide personalised education.