What are the treatments for eye strain?

Treatment for Eye Strain

For eye strain, prioritize environmental modifications and behavioral interventions first, followed by artificial tears for associated dry eye symptoms, as no high-certainty evidence supports any specific pharmacological therapy for reducing visual fatigue itself. 1

First-Line Behavioral and Environmental Interventions

The American Academy of Ophthalmology recommends the following environmental modifications to reduce eye strain symptoms:

• Lower computer screens below eye level to decrease eyelid aperture and reduce evaporative tear loss 2, 3
• Increase conscious blinking (>10 times/minute) during screen use, as decreased blink frequency causes ocular surface desiccation and dry eye-like symptoms 2, 4
• Humidify ambient air and avoid air drafts by using side shields on spectacles 2, 3
• Eliminate cigarette smoke exposure, which adversely affects the tear film lipid layer 2, 3

The 20-20-20 Rule Controversy

While the 20-20-20 rule (fixating on an object 20 feet away for 20 seconds every 20 minutes) is widely cited, a 2023 randomized trial found no significant effect of scheduled 20-second breaks on reported symptoms, reading speed, or task accuracy 5. Despite this, the rule remains commonly recommended in clinical practice for lack of better alternatives 6, 7.

Treatment for Associated Dry Eye Symptoms

Since eye strain frequently presents with dry eye symptoms, the American Academy of Ophthalmology recommends:

• Preservative-free artificial tears (methylcellulose or hyaluronate-based) at least 4 times daily, increasing frequency up to hourly based on symptom severity 2, 3
• Lubricating ointment at bedtime for overnight protection if ocular surface symptoms are present 3
• Avoid preserved artificial tears more than 4 times daily, as overuse causes ocular surface toxicity 3

Lid Hygiene for Concurrent Blepharitis

If crusting or meibomian gland dysfunction accompanies eye strain:

• Warm compresses for 5-10 minutes twice daily using battery-powered or microwaveable eyelid warming devices 2, 3
• Gentle lid massage after warm compresses to express thickened meibomian gland secretions 2, 3
• Cleanse eyelid margins using diluted baby shampoo or commercial eyelid cleaners to remove crusting 3

Anti-Inflammatory Therapy for Refractory Cases

For persistent symptoms despite initial measures:

• Topical cyclosporine 0.05% twice daily can be considered, with success rates of 74% in mild, 72% in moderate, and 67% in severe dry eye 2
• Short-term topical corticosteroids (such as loteprednol) for 2-4 weeks maximum during acute exacerbations, but never exceed this duration due to risks of increased intraocular pressure, cataracts, and infections 2

Nutritional Supplementation Evidence

The 2022 American Academy of Ophthalmology systematic review found:

• Oral omega-3 supplementation for 45 days to 3 months improved dry eye symptoms (mean difference -3.36 on an 18-unit scale) in symptomatic computer users, though this was low-certainty evidence 1
• Berry extract supplementation did not improve visual fatigue (7 RCTs; P = 0.22) or dry eye symptoms (4 RCTs; P = 0.65) 1
• Oral carotenoid supplementation improved critical flicker-fusion frequency, though the clinical significance is unclear 1

Addressing Convergence Insufficiency

If eye strain persists despite the above measures, consider convergence insufficiency as a cause, particularly in patients aged 15-40 years 8. This requires:

• Orthoptic exercises as the primary treatment 8
• Referral to an optometrist or ophthalmologist for formal convergence testing and vision therapy

Red Flags Requiring Ophthalmology Referral

The American Academy of Ophthalmology recommends immediate ophthalmology referral if patients develop:

• Moderate or severe eye pain 2
• Vision loss or blurred vision 2
• Corneal infiltration or ulceration 2
• Lack of response to initial therapy after 2-4 weeks 2, 3

Common Pitfalls to Avoid

• Do not prescribe glasses for eye strain without evaluating for convergence insufficiency, as many patients receive unnecessary optical correction when orthoptic exercises are needed 8
• Do not recommend blue light blocking glasses, as there is lack of supporting evidence and no compelling biological mechanism for blue light causing eye strain directly 1
• Recognize that complete symptom elimination may be difficult, as the 2022 systematic review found no high-certainty evidence supporting any specific therapy for visual fatigue 1