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Computer Vision Syndrome: an Update

Article  in  British Journal of Neuroscience Nursing · April 2019

DOI: 10.12968/bjnn.2019.15.Sup2.S10

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Computer vision syndrome: an update

Sushma Dhar-Munshi, Souad Amed and Sunil Munshi

I
n recent years, clinicians have
observed that the prolonged use
of visual display units (VDUs)
can result in a certain symptom
complex, which has been defined
as computer vision syndrome (CVS)
or digital eye strain. The condition
presents with a number of different
ocular and non-ocular symptoms.
Incorrect diagnosis is the main concern
among physicians, as the syndrome
is often confused with the symptoms
of a transient ischaemic attack (TIA),
which include eye strain and transient
blindness. Raising awareness among
both physicians and the public is
vital to avoid incorrect diagnosis and
unnecessary, harmful medications and
medical interventions. This can be
achieved through ensuring a thorough
and focused history is obtained. Simple
precautions, including appropriate
screen time and illumination, can
prevent or alleviate the symptoms.
Computer vision syndrome (CVS)
is common in individuals who use
visual display units (VDUs), such as
computers, tablets, smart phones etc. for
more than 3 hours a day at a distance of
less than 6 metres (Klamm and Tarnow,
2015). The severity of symptoms
is proportional to the amount of
computer use (Hayes et al, 2007;
Parihar et al, 2016). In all probability,
these devices do not cause permanent
damage to the visual pathway (Council
on Scientific Affairs, American Medical
Association, 1987; Mutti and Zadnik,
1996; Portello et al, 2012; Porcar et al,
2016).
Authors Sushma Dhar Munshi, Consultant
Ophthalmologist, Sherwood Forest Hospitals
NHS Trust; Souad Amed, Foundation Trainee,
Differential diagnosis
Several conditions may produce
transient visual symptoms and present
to the TIA/stroke/neurovascular clinic.
These include migraine, amaurosis
fugax due to carotid artery disease,
temporal arteritis, optic neuritis,
intermittent narrow-angle glaucoma,
non-organic causes and computer vision
syndrome. Appropriate history and
investigations are crucial for each of
these conditions.
What are the symptoms of
computer vision syndrome?
Symptoms of CVS can be divided
into four main types: visual, ocular
surface-related, asthenopic and extra-
ocular, as depicted in Table 1 (Klamm
and Tarnow, 2015). Refractive errors,
poor computer design and workplace
ergonomics, and a highly demanding
visual task, can all contribute to the
development of visual symptoms and
complaints.
Table 1. Major categories of symptoms in computer vision syndrome
Symptom category Symptoms
Asthenopic Eye strain
Tired eyes
Sore eyes
Ocular surface related Dry eyes
Watery eyes
Irritated eyes
Contact lens problems
Visual Blurred vision
Slowness of focus change Accommodation
Double vision
Presbyopia
Transient blindness
CVS is thought to be due to
repetitive strain injury, with symptoms
frequently being work-related. They
often disappear with discontinuation of
work, and return on recommencement
of work.
What are the other signs to look
for in suspected CVS?
■■ Individuals with under-corrected
myopia, astigmatism and presbyopia
are more prone to the development
of CVS (Tsubota and Nakamori,
1993)
■■ Maintaining the same posture for a
long period of time can contribute
significantly to muscular problems
like neck, back and shoulder pain.
■■ Other common differential diagnoses
for dry eye also include reactions to
drugs or systemic diseases, especially
auto-immune diseases.
■■ Correct lighting in the workplace is
important as a preventative measure
of CVS. People over 50 years of age
Possible causes
Binocular vision
Accommodation
Infrequent blinking
Refractive error
Binocular vision
Presbyopic correction
Bleaching of photopigment, with
© 2019 MA Healthcare Ltd

the viewing eye becoming light-

Sunil Munshi, Consultant Physician, both of
Department of Stroke, Nottingham University
adapted
Hospitals NHS Trust Extra-ocular Neck pain Computer screen location
Correspondence: Back pain
sunil.munshi@nuh.nhs.uk Shoulder pain

S4 BJNN/Stroke Association Supplement  April/May 2019

 COMMENT

managed appropriately, and that

KEY POINTS unnecessary treatments, such as lifelong
antithrombotic therapy and other
■ Computer vision syndrome is a repetitive strain disorder
unnecessary medications, are ultimately
avoided.  bjnn
■ Patients may present to a variety of specialists

■ Symptoms are predominantly ocular but extra-ocular symptoms may occur

Conflicts of interest: The authors have no conflicts

■ Diagnosis needs to be precise
of interest to declare.

■ It may be mistaken for amaurosis fugax with unnecessary lifelong medications

■ Simple ergonomic measures may help prevent or alleviate it Alim-Marvasti A, Bi W, Mahroo OA, Barbur JL,
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