What are the recommendations for managing eye strain?

Management of Eye Strain

The most effective approach to managing eye strain is through a combination of ergonomic adjustments, visual hygiene practices, and limited use of ocular lubricants, as there is no high-certainty evidence supporting any single intervention for computer vision syndrome. 1

Understanding Eye Strain

Eye strain, often referred to as Computer Vision Syndrome (CVS), affects approximately 75-90% of computer users and is characterized by:

• Eye fatigue and discomfort
• Blurred vision
• Dry eyes
• Headaches
• Neck and shoulder pain

Evidence-Based Management Strategies

1. Ergonomic Adjustments

• Screen Position: Position monitor at eye level, about arm's length away
• Lighting: Reduce glare and reflections from surrounding lighting 1
• Environmental Factors: Maintain adequate humidity (>40%) as low humidity is a risk factor 1
• Work Breaks: While the popular 20-20-20 rule (looking at something 20 feet away for 20 seconds every 20 minutes) is widely recommended, recent research questions its effectiveness 2

2. Visual Hygiene

• Apply ocular lubricants (e.g., nonpreserved hyaluronate or carmellose eye drops) when experiencing dryness 1, 3
• Maintain proper blinking: Reduced blink rate during digital device use contributes to dry eye symptoms 4
• Contrast and Font Size: Increase text size and contrast on digital devices 1
• Reduce Blue Light: Consider using night mode or blue light filters on devices, although evidence for blue-blocking spectacles shows low certainty of benefit 1

3. Optical Correction

• Ensure proper refractive correction: Uncorrected refractive errors, including astigmatism and presbyopia, can worsen eye strain 4
• Consider specialized eyewear: For those with significant computer use, computer-specific prescriptions may be beneficial 1
• Contact lens wearers: May need more frequent breaks or lubricating drops as they are at higher risk for digital eye strain 4

4. Nutritional Supplements

• Omega-3 supplementation: Low-certainty evidence suggests oral omega-3 supplements (taken for 45 days to 3 months) may reduce dry eye symptoms in computer users 1
• Other supplements: Berry extracts and most other nutritional supplements have not shown significant benefits for visual fatigue or dry eye symptoms 1

Special Considerations

For Convergence Insufficiency

• Convergence insufficiency can cause eye strain, particularly in individuals aged 15-40 5
• Orthoptic exercises may be beneficial for those diagnosed with convergence insufficiency 5

For Prolonged Digital Device Users

• Digital device use increased significantly during the COVID-19 pandemic, with digital eye strain incidence reported at 78% during periods of isolation 6
• High-risk groups (computer workers, contact lens wearers) may need more aggressive management strategies 4

Monitoring and Follow-up

• If symptoms persist despite these interventions, a comprehensive eye examination is warranted to rule out underlying ocular conditions
• For those using artificial tears frequently (more than 4 times daily), preservative-free formulations are recommended to avoid preservative toxicity

The management of eye strain requires addressing multiple factors simultaneously, as no single intervention has demonstrated high-certainty evidence of effectiveness for all symptoms of computer vision syndrome.