Welcome to question of the day #224

Eyetools question of the day #224

My last patient spends about 7 hours per day working at a computer screen and several hours on top of this looking at his smartphone. At the end of most workdays he complains of blurred vision, eye irritation, headaches and neck pain? He wears glasses with a +1.50 DS prescription for each eye, has excellent distance and near vision with a 10 prism dioptre exophoria at near and no other binocular vison anomaly. What is going on?

It sounds like your patient has computer vision syndrome. While there is no evidence that excessive screen time causes any long-term damage to the eyes it can lead to transient eye, head, neck and shoulder discomfort reducing work efficiency and a making life generally miserable.

People with computer vision syndrome complain of:

Blurred vision

Double vision

Dry, red eyes

Eye irritation


Neck or back pain.

These are all become worse the longer the screen time continues and are much less or none existent on days with no screen time such as when on holiday.

Changes to the workspace and periods away from the screen will help reduce these signs and symptoms. Here are some suggestions:

If light from a window or a light creates glare on the screen, move the light or move away from the light and shade the window. Or, buy a desk lamp with a moveable shade that casts light evenly over the desk. You can also add a glare filter to your monitor.

The best position for a screen is just below eye level, about 20 to 28 inches away from the face. There shouldn’t be a need to stretch the neck or strain the eyes to see what’s on the screen. A reading stand next to the monitor to hold place any printed materials will mean there is no need to have to look up at the screen and back down at the desk. This will help reduce blurred and double vision.

The 20-20-20 rule may be useful. Look away from the screen every 20 minutes or so and look at something around 20 feet away for about 20 seconds. Blink often to keep the eyes moist. If they feel dry, try artificial eye drops. This will help with headaches, eyestrain and dry and red eyes.

 Adjust the brightness, contrast, and font size until you find what suits best. Some people like to work at a desk that can be adjusted so that they can stand up while working.

What works best for me is after about an hour to get up from where I’m working and go and do something else. That something may be to make a drink or get some food or it may be work related but the standing up, moving and being away from the screen will help blood move in a different way around the body and allow more of muscles to move. And to repeat this every hour. This will help with neck and shoulder discomfort.

I also try not to spend all of my free time looking at a screen.

Advising your patient along these lines will help reduce their eye and posture problems, improve their work performance and improve their quality of life.