Disease Entity

Asthenopia

Definition

Eyestrain
Subjective symptoms of ocular fatigue, discomfort, lacrimation, and headaches arising from the use of eyes.
Weakness or tiring of eyes accompanied by pain, headache, blurry vision, sensitivity to light or inability to keep the eyes open.

Etiology

Accommodative asthenopia: strain of ciliary muscle and refractive error. This is probably the most common form of asthenopia seen in uncorrected presbyopic and pre-presbyopic patients with hyperopia as well as in myopic patients that were overminused prescriptions
In addition to uncorrected refractive error, convergence insufficiency and accommodative spasm are common ocular causes for headache^[1]
Photogenous asthenopia: excessive or improper illumination.
Muscular asthenopia: due to imbalance of the extraocular muscles
Nervous asthenopia: due to functional or organic nervous disease, commonly seen in anxiety

Diagnosis

A complete eye exam is required to rule out intraocular causes of pain, such as angle closure glaucoma, uveitis, or optic neuritis
Also evaluate for dry eye and meibomian gland dysfunction

Symptoms

Pain in and around eyes
Headache, usually aggravated by use of eyes for close work
Fatigue
Vertigo
Reflex symptoms as nausea, twitching of facial muscles, migraine.
May be associated with increased screen time, recently related to the COVID pandemic^[2]

Management

Treatment of the underlying cause is first line, therefore an eye exam is warranted with glasses prescription as necessary, correction of strabismus and artificial tears, lid hygiene and warm compresses for dry eyes. By far, the most important component of the management of this condition consists in prescribing the appropriate glasses especially in hyperopic patients, including treatment of presbyopia. Cycloplegia is indicated in patients under the age of 30 years to diagnose the entire amount of hyperopia as well as to prevent overminusing in myopic patients.

Avoiding prolonged use of computer devices (more than 2 hours) and short brakes for eye rest helps relieve the symptoms. Analgesic drugs may also be prescribed for this condition.

Treatment

Correct any refractive error
Consider bifocals, prisms, or orthoptic training for convergence insufficiency, or rarely surgery^[1]
Consider glasses or cycloplegia for accommodative spasm^[1]
Consider limiting screen time

Additional Resources

Celia Vimont Laurie Gray Barber. Eye Strain. American Academy of Ophthalmology. EyeSmart/Eye health. https://www.aao.org/eye-health/diseases/eye-strain-list. Accessed March 29, 2019.
Tsai CL. AR Computers To Terminate Eyestrain And Myopia. EyeWiki. https://eyewiki.org/AR_Computers_To_Terminate_Eyestrain_And_Myopia Accessed April 05, 2023.

References

Taber's Cyclopedic Medical Dictionary
Stedman's Medical Dictionary

↑ ^1.0 ^1.1 ^1.2 Nguyen E, Inger H, Jordan C, Rogers D. Ocular Causes for Headache. Semin Pediatr Neurol. 2021 Dec;40:100925. doi: 10.1016/j.spen.2021.100925. Epub 2021 Sep 5. PMID: 34749915.
↑ Mohan, Amit; Sen, Pradhnya; Shah, Chintan; Jain, Elesh; Jain, Swapnil. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1). Indian Journal of Ophthalmology 69(1):p 140-144, January 2021. | DOI: 10.4103/ijo.IJO_2535_20

[:0-1] 1.0 ^1.1 ^1.2 Nguyen E, Inger H, Jordan C, Rogers D. Ocular Causes for Headache. Semin Pediatr Neurol. 2021 Dec;40:100925. doi: 10.1016/j.spen.2021.100925. Epub 2021 Sep 5. PMID: 34749915.

[2] Mohan, Amit; Sen, Pradhnya; Shah, Chintan; Jain, Elesh; Jain, Swapnil. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1). Indian Journal of Ophthalmology 69(1):p 140-144, January 2021. | DOI: 10.4103/ijo.IJO_2535_20

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