Eye Strain

What is Eye Strain?

Eye strain is a group of eye and vision symptoms that build up after prolonged close visual work, most often on digital screens.^[1] It is also called asthenopia, digital eye strain or computer vision syndrome, and symptoms are usually temporary but can be frequent and persistent.^[1]

Common symptoms

The typical symptoms are tired eyes, dryness, burning, itching, a gritty feeling, watering and blurred vision.^[2] Headache, neck and shoulder pain and general fatigue often come with it.^{[2, 3]}

Researchers group these symptoms into two types. One type comes from the effort of focusing and keeping the two eyes aligned, and the other comes from dry eye.^[1]

Causes and risk factors

Eye strain has many contributors, and a single symptom can have more than one cause.^[4] Uncorrected vision problems such as astigmatism or presbyopia, problems with focusing or eye alignment, reduced or incomplete blinking, glare, a short working distance and small text are all linked to it.^[4]

A meta-analysis of 103 studies estimated that about 7 in 10 people have computer vision syndrome, with higher rates in women and contact lens wearers, although the studies differed widely.^[5] A meta-analysis found that visual display use raised the rates of eye pain, fatigue, blurred vision and dry eyes.^[6]

How it is diagnosed and treated conventionally

An eye care professional diagnoses the cause with a vision exam, which can find refractive error and focusing or alignment problems.^{[4, 7]} Treatment depends on the cause. Suggested measures include correcting refractive error, treating binocular vision problems, blinking exercises, lubricating drops, screen breaks and an ergonomic workspace.^{[3, 4]}

Common marketed fixes have limited support. A Cochrane review found blue-light filtering lenses may not reduce eye strain symptoms with computer use, and a review of 45 trials found no high-certainty evidence for any of the treatments it examined.^{[8, 9]}

Why Eye Strain calls for a whole-person approach

Eye strain rarely has just one cause. The eye surface, the focusing muscles, the neck and shoulders, and the way a person works all take part, and a review recommends a holistic look at all of them.^[4]

Care that adds relaxation, comfort and attention to body tension is therefore a reasonable complement to the eye exam and practical changes that come first.

Blinking and the eye surface

Screen work lowers blink rate and makes blinks incomplete, which dries the eye surface and produces dry-eye-like symptoms.^{[3, 10]} For this reason, dry eye is often treated alongside eye strain.^[4]

Focusing and eye alignment

Close work asks the eyes to focus and turn inward for long periods. With screens, focusing can lag and the eyes' ability to converge can drop.^[10] Convergence insufficiency, a binocular vision disorder, is a known cause of eye strain, headache and blurred vision.^[7]

Neck, shoulder and head tension

Neck and shoulder pain and headache are among the common symptoms of digital eye strain.^[3] Poor ergonomics during screen use were linked to higher symptom scores in a review of young screen users.^[11]

Screen time and workspace

In the same review, screen use of more than 4 to 5 hours a day was associated with more eye strain symptoms, and the authors suggest limiting screen time and improving ergonomics.^[11] Regular breaks and changing focus to something distant are standard advice.^[2]

Acupuncture for Eye Strain

What the research shows

The evidence on acupuncture for eye strain is limited. We found no systematic review of acupuncture for eye strain, and the trials we found are small and mostly from China.

A trial of 80 people with eye strain from convergence insufficiency compared acupuncture with eye drops. Acupuncture had higher effective rates at 2 and 4 weeks, but the trial was not placebo-controlled.^[12] A trial of 152 people with dry eye and computer vision syndrome found that acupuncture, alone or with a Chinese herbal granule, improved tear stability and some computer-related symptom scores (physical and cognitive symptoms) more than eye drops.^[13] A pilot study of 15 women with eye strain found that warm stimulation at a leg acupuncture point raised eye temperature and lowered symptom scores compared with control points.^[14]

Studies of acupuncture for dry eye itself are discussed on our dry eye page, because dry eye drives many eye strain symptoms.

How acupuncture may work

How acupuncture might ease eye strain is not established. In the small pilot study, stimulation at a distant point raised the temperature around the eyes, which the author took as a sign of altered local blood flow.^[14] This is a proposed explanation from a very small study and not a settled mechanism.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points around the eyes, face, head, neck and sometimes the hands and legs, usually left in place for about 20 to 40 minutes. The trials above gave treatment for 2 to 4 weeks.^{[12, 13]} We reassess after a short course of visits.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or bruising, and serious events occurred in about 1 in 10,000 patients.^[15] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Eye Strain

The Ayurvedic view

Ayurvedic authors have described computer vision syndrome as a Vata-Pitta disorder of the eyes and the body, brought on by overuse of the eyes.^[16] In this traditional framework, dryness, heat and strain are the signs of imbalance. These are traditional categories for choosing treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular daily routine, sleep and meals, with planned rest from near work
• Cooling, soothing care such as a cold eye pack, which has been tested in a trial^[17]
• Gentle head, face and neck massage with oil
• Trataka, a yogic steady-gazing practice taught as an eye exercise, which has been tested in a trial^[17]
• Herbs such as shatavari, used in a study of Ayurvedic care for computer vision syndrome^[16]

Eye therapies such as Netra Tarpana are traditionally used in Ayurvedic ophthalmology. Anything placed in or around the eye should have your eye doctor's agreement. Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty.

What the research shows

The research on Ayurveda for eye strain is limited. A pilot study of 30 patients with computer vision syndrome gave an oral Shatavari-based powder plus a ghee eye therapy (Netra Tarpana) to one group. Only that group improved significantly, while eye treatment alone or advice on working conditions alone did not.^[16] The groups were small and the study was not placebo-controlled.

A randomized trial of 300 IT workers found that two weeks of trataka or a cold eye pack improved self-rated visual strain more than waiting, with no difference between the two. There was no blinding and no sham control.^[17] Trataka is a yogic eye practice, and the cold pack is a general comfort measure, so this does not show that Ayurvedic medicine itself works.

Herbal medicine for Eye Strain

Herbs and formulas that have been studied

Bilberry extract, a Western herb, has been studied in screen workers.^{[9, 18]} Chinese herbal formulas have also been studied, for example Yiqi Congming decoction granules in people with dry eye and computer vision syndrome.^[13]

What the research shows

The evidence is limited and mixed. In a placebo-controlled trial of 88 office workers in Japan, 8 weeks of bilberry extract eased some measures of screen-related eye fatigue, including the fatigue sensation, eye pain and heaviness, with no severe adverse events.^[18]

A larger review of 45 trials, however, found that berry extracts did not reduce visual fatigue or dry eye symptoms compared with placebo (7 and 4 trials respectively).^[9] In the Chinese trial of 152 people, the herbal granule improved tear meniscus height and symptoms but was not better than acupuncture on several measures, and it was not placebo-controlled.^[13]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. A literature review, mostly of case reports, found enhanced warfarin effect or bleeding with herbs such as dan shen (Salvia miltiorrhiza), garlic and ginkgo, and bleeding when ginkgo was combined with aspirin.^[19] People taking blood thinners need a practitioner's review before using herbs.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have diabetes or liver or kidney disease, or have surgery planned. Do not put herbal preparations in your eyes unless your eye doctor agrees.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often relates tired eyes to weak nourishment of the eyes, and treatment points around the eyes, head and neck are chosen to ease that. Researchers instead look at the eye surface and tear film, the focusing system and local blood flow.^{[1, 14]}

In Ayurveda, the Vata and Pitta pattern describes dryness, heat and strain from overuse of the eyes.^[16] This loosely parallels the two symptom groups researchers describe, with dry-eye-like symptoms on one side and focusing stress on the other.^[1] No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for eye strain is complementary. Keep your eye doctor, and do not stop or change prescribed glasses, drops or medicines without their advice. We do not diagnose the cause of eye strain, so persistent symptoms should be evaluated with an eye exam, because uncorrected vision or binocular vision problems are common causes.^[4]

Please bring your latest eye exam results and glasses or contact lens prescription, a list of eye drops, medicines and supplements, and a note of how many hours a day you work on screens.

When to seek urgent medical care

Ordinary eye strain does not cause lasting eye damage, but some symptoms point to a different and more serious problem that needs prompt examination.

• Sudden loss of vision, or a curtain or shadow across your vision
• Severe eye pain, or a red painful eye with nausea
• New double vision, or flashes and many new floaters
• Eye symptoms with sudden severe headache, weakness, confusion or trouble speaking
• Eye symptoms after an injury or chemical splash

If any of these occur, call 911 or go to the nearest emergency department.