Managing Visual Symptoms of Eyestrain from Prolonged Screen Time
For computer-related eye strain, focus on environmental modifications, proper refractive correction, and omega-3 supplementation for dry eye symptoms—blue light-blocking glasses provide no benefit and should not be recommended. 1, 2
What Blue Light Filters Don't Work
The American Academy of Ophthalmology explicitly states that blue light-blocking lenses provide no benefit for eye strain compared to non-filtering lenses. 2 Multiple randomized controlled trials found no significant difference in visual fatigue scores between blue-blocking spectacles and regular lenses (3 RCTs, low-certainty evidence). 1 Even filters that blocked 99% of wavelengths between 400-500 nm showed no reduction in digital eye strain symptoms compared to neutral-density filters. 3
Primary Environmental and Ergonomic Interventions
Address these modifiable risk factors systematically:
- Reduce screen reflections and glare from surrounding lighting, as this is an established risk factor for computer vision syndrome. 1, 2
- Maintain humidity above 40% in the workspace, as low humidity contributes to ocular surface symptoms. 1, 2
- Optimize screen positioning with proper viewing distance and ergonomics to reduce extraocular muscle strain. 1, 2
- Limit extended computer use when possible, as more than 4 hours daily significantly increases risk of computer vision syndrome. 1, 2
The 20-20-20 Rule: Limited Evidence
While the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds) is widely cited, a 2023 study found no significant effect of scheduled breaks on reported symptoms, reading speed, or task accuracy during digital device use. 4 Despite this, the rule may still provide subjective relief and is low-risk to implement. 2
Refractive Correction Matters
Ensure proper refractive correction, including residual astigmatism. 2, 5 Contact lens wearers with uncorrected residual astigmatism experienced reduced visual fatigue when this was corrected (very low-certainty evidence). 1 Eye care professionals should weigh potential benefits of contact lenses for multiple-distance correction against possible lens-associated ocular surface disruption. 5
Evidence-Based Supplementation
For patients with prominent dry eye symptoms accompanying their eye strain, recommend oral omega-3 supplementation for 45 days to 3 months. 1, 2 This significantly improved dry eye symptoms in two RCTs (mean difference -3.36 on an 18-unit scale; 95% CI -3.63 to -3.10; P<0.00001), though evidence certainty is low. 1
Berry extract supplementation (bilberry, maqui berry) showed no improvement in visual fatigue or dry eye symptoms across multiple trials. 1
Symptomatic Relief
- Use artificial tears as needed for temporary relief of burning, irritation, and discomfort due to dryness. 2, 6
- Practice conscious blinking exercises to maintain tear film stability. 2
- Consider punctal occlusion for severe cases not responding to conservative measures. 7
When to Refer to Ophthalmology
Refer patients who experience:
- Moderate or severe eye pain 7
- Lack of response to over-the-counter lubricating drops 7
- Progressive worsening of vision 7
- Symptoms significantly impacting quality of life 7
Common Pitfalls to Avoid
Do not recommend blue light-blocking glasses—despite aggressive marketing, there is no evidence they reduce eye strain symptoms. 1, 2, 3 The relatively low level of blue light emission from electronic devices and lack of compelling biological mechanism make this intervention ineffective. 1
Do not overlook the strong correlation between digital eye strain and dry eye disease. Among students diagnosed with digital eye strain symptoms, 26.5% had mild to moderate dry eye symptoms and 8.2% had severe dry eye symptoms, suggesting dry eye prevalence may be underestimated in screen users. 8