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Asthenopia: Eye Strain Causes and Treatment

Asthenopia refers to eye strain characterised by symptoms such as blurred vision, headaches and burning eyes, often triggered by prolonged near work.

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Things worth knowing about "Asthenopia"

Asthenopia refers to eye strain characterised by symptoms such as blurred vision, headaches and burning eyes, often triggered by prolonged near work.

What is Asthenopia?

Asthenopia (from the Greek asthenes meaning weak and ops meaning eye) describes a condition of excessive eye strain accompanied by a variety of symptoms affecting the eyes and head. Symptoms typically occur after prolonged near work, such as reading, writing, or working on a screen. Asthenopia is not an independent disease but rather a symptom complex indicating overstrain of the visual system.

Causes

The causes of asthenopia can be divided into two main groups:

Accommodative Causes

Refractive errors such as farsightedness (hyperopia), nearsightedness (myopia), or astigmatism that are uncorrected or inadequately corrected
Overloading of the ciliary muscle, which is responsible for focusing at different distances
Presbyopia (age-related loss of near focusing ability), in which the natural lens loses its elasticity

Muscular and Binocular Causes

Heterophoria (latent squint): a hidden misalignment of the eyes that is continuously compensated by muscular effort
Disorders of eye muscle coordination and binocular vision
Insufficient convergence ability during near work

External and Environmental Causes

Prolonged screen use (Computer Vision Syndrome)
Poor lighting conditions or glare
Dry eyes (sicca syndrome), often caused by reduced blinking during screen work
Incorrect reading distance or poor workplace ergonomics

Symptoms

The symptoms of asthenopia are varied and may occur individually or in combination:

Burning, stinging or watering eyes
Blurred or double vision, especially during near work
Difficulty focusing, particularly when switching between different distances
Headaches, often above the eyes or at the forehead
Neck and shoulder pain due to compensatory postural changes
General fatigue and difficulty concentrating
Sensitivity to light (photophobia)

Diagnosis

Asthenopia is diagnosed by an ophthalmologist or a qualified optometrist. Common examinations include:

Visual acuity testing for near and distance vision
Determination of refraction to identify refractive errors
Assessment of accommodative amplitude and endurance
Evaluation of binocular vision and eye muscle balance (heterophoria testing)
Assessment of tear film quality to rule out dry eye syndrome

Treatment

Treatment is directed at the underlying cause:

Optical Correction

Adjustment or new prescription of glasses or contact lenses to correct refractive errors
Specialised computer glasses for screen work
Prism lenses in cases of heterophoria to relieve the eye muscles

Behavioural and Environmental Measures

Regular breaks following the 20-20-20 rule: every 20 minutes, look at something 20 feet (approx. 6 metres) away for 20 seconds
Optimising workplace ergonomics: correct screen distance, adjusted screen brightness, avoidance of glare
Use of lubricating eye drops (artificial tears) for dry eyes
Improvement of workplace lighting

Therapeutic Measures

Vision therapy (orthoptic exercises) for problems with binocular vision or convergence
Treatment of underlying dry eye disease by an ophthalmologist

Prognosis and Prevention

The prognosis of asthenopia is generally good when the underlying cause is addressed. With consistent correction of refractive errors, regular breaks, and ergonomic workplace adjustments, symptoms can be significantly reduced or completely resolved. Regular eye examinations are particularly recommended for individuals who spend many hours per day working on screens.

References

Rosenfield, M. - Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic and Physiological Optics, 31(5), 502-515 (2011). PubMed PMID: 21480937.
American Academy of Ophthalmology (AAO) - Asthenopia. EyeWiki. https://eyewiki.aao.org/Asthenopia (accessed 2024).
Sheedy, J.E., Hayes, J., Engle, J. - Is all asthenopia the same? Optometry and Vision Science, 80(11), 732-739 (2003). PubMed PMID: 14627938.

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