Can dry eyes or eye strain exacerbate myopia symptoms?

Dry Eyes and Eye Strain Do Not Make Myopia Worse

Dry eyes and eye strain do not directly exacerbate or worsen myopia (nearsightedness), though they may temporarily affect visual comfort and clarity. 1, 2

Understanding Dry Eye and Eye Strain

Dry eye disease (DED) is a multifactorial disorder of the tear film characterized by:

• Reduced tear production or tear film instability
• Ocular discomfort and/or visual symptoms
• Inflammatory disease of the ocular surface 1

Eye strain often occurs due to:

• Increased screen time (computers, phones, TVs)
• Reduced blink rate
• Environmental factors (air conditioning, low humidity)
• Prolonged visual efforts (reading, computer use) 1, 2

Relationship Between Dry Eye/Eye Strain and Myopia

Key Facts:

• Dry eye and eye strain can cause temporary visual discomfort and fluctuating vision but do not alter the eye's refractive error or axial length (the underlying causes of myopia) 2
• Myopia is primarily caused by:
  • Environmental factors (reduced outdoor time, increased near work)
  • Genetic factors
  • Not by dry eye or eye strain directly 3, 4

Digital Eye Strain Considerations:

• Digital device use is associated with both dry eye symptoms and myopia progression, but these are separate mechanisms 5
• While digital eye strain may include symptoms like blurred vision, this is temporary and does not represent a worsening of the underlying myopia 5

Management Strategies

For Dry Eye:

1. Environmental modifications:

   • Humidify ambient air
   • Avoid air drafts
   • Practice conscious blinking
   • Lower computer screens below eye level 2

2. Artificial tears:

   • For mild symptoms: preserved tears (≤4 times/day)
   • For moderate symptoms: preservative-free tears (>4 times/day)
   • Consider lipid-containing formulations for meibomian gland dysfunction 2

3. For persistent symptoms:

   • Prescription medications (cyclosporine, lifitegrast)
   • Short-term topical corticosteroids for acute flares 2

For Eye Strain:

• Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds 5
• Take regular breaks from screen time
• Ensure proper lighting and minimize glare
• Maintain proper ergonomics 2, 5

Important Considerations

Potential Confusion:

• Patients may perceive worsening myopia when experiencing dry eye symptoms because:
  • Dry eye causes fluctuating vision and temporary blurring
  • These symptoms may be mistaken for worsening myopia 1

Special Situations:

• Dry eye is common after refractive surgery (including LASIK) and cataract surgery 1
• Pre-existing dry eye should be treated before considering refractive surgery 2
• Contact lens wearers with dry eye may need more aggressive therapy 2

Bottom Line

While dry eyes and eye strain can cause discomfort and temporary visual disturbances, they do not cause structural changes that would worsen myopia. Proper management of these conditions will improve comfort and visual clarity but will not alter the underlying refractive error.