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Asthenopia

Asthenopia, also known as eyestrain, is an ocular condition which is seen frequently amongst students and computer operators. It is caused by long hours of near work leading to eye fatigue. Asthenopia can be of either the accommodative type or the muscular type and the two types can be differentiated with a patch test.


Presentation

Asthenopia is becoming a public health problem due to lifestyle changes and increasing usage of computers in colleges and various industries [1] [2]. The term asthenopia includes several different clinical manifestations arising secondary to the excessive use of eyesight [3] [4] [5]. The symptoms are found to have a female preponderance with high school students presenting with ocular symptoms more frequently compared to primary school children due to their increasing use of computers [5]. Specific ocular clinical manifestations are photophobia, blurring of vision, eye redness, diplopia, itching of eyes, excessive tearing, dry eyes, and foreign body sensation [3] [6]. Other symptoms include headaches, eye soreness, fatigue, and irritation [3] [4] [5] [6]. Severe symptoms of asthenopia have been reported to accelerate age-related ocular diseases [7], reduce productivity and quality of life [8] [9]. Factors postulated to have a strong association with asthenopia include computer usage, psychosocial status, environment conditions, posture, and diet.

Asthenopia is classified as either internal or external [3].

  • Internal or accommodative asthenopia presents with eye strain and pain inside the eyes and is due to ciliary muscle overuse [3] [6]. It can be caused by uncorrected refractive errors, convergence and accommodation insufficiency, or decompensated heterophoria [6] [10].
  • External or muscular asthenopia is due to extraocular muscle weakness and presents with dryness and irritation of the eyes. It is associated with nerve palsies, strabismus, glare from lights, flickering stimuli from computer displays, and dry eyes [3].
Falling
  • In general, the frequency and severity of these symptoms fall into three main groups or factors (Figure 2). Symptoms of eyestrain, soreness, tired eyes and headache all fall together in one grouping called primary global sensations.[reviewofoptometry.com]
  • Vision disorder makes 3-D fall flat for some. 18 May 2010: . Accessed 29 Sept 2010. 28. Hoffman DM, et al. Vergence-accommodation conflicts hinder visual performance and cause visual fatigue. J Vision. 2008; 8:1-30. 29.[mivision.com.au]
Nausea
  • PURPOSE: Watching three-dimensional (3D) images is known to induce ocular and non-ocular symptoms, such as eye discomfort, fatigue, headache, and nausea, which can be referred to as "3D asthenopia".[ncbi.nlm.nih.gov]
  • Muscular asthenopia: due to imbalance of the extraocular muscles Nervous asthenopia: due to functional or organize nervous disease Symptoms Pain in and around eyes Headache, usually aggravated by use of eyes for closework Fatigue Vertigo Reflex symptoms as nausea[eyewiki.aao.org]
  • Symptoms include pain in or around the eyes, headache, dimness of vision, dizziness, and slight nausea. as·the·no·pi·a ( as'thĕ-nō'pē-ă ) Subjective symptoms of ocular fatigue, discomfort, lacrimation, and headaches arising from use of the eyes.[medical-dictionary.thefreedictionary.com]
  • At times, the intensity of the headaches associated with asthenopia can be considerable and may even result in migraines with nausea and vomiting. B) Myopia.[eyecos.eu]
  • Symptoms Asthenopia may include the following symptoms: Headache Nausea Fatigue Sleepiness Light sensitivity Blurred vision Eye strain Eye soreness Eye pain Burning eyes Dry eyes Difficulty reading Irritability Poor concentration Causes Asthenopia seems[vision.about.com]
Hypertension
  • […] fluorescein dye dilution test Soft or Hard contact lens use 3 or more days a week History of oral intake of health supplement designed to improve asthenopia within 4 weeks before participating this study Pregnant woman Systemic disease Uncontrolled hypertension[clinicaltrials.gov]
  • Out of all respondents, only 1 (0.2%) was diabetic and 4 (1.0%) were hypertensive.[ncbi.nlm.nih.gov]
Low Back Pain
  • Asthenopia symptoms such as "stiff shoulder, low back pain", "frustration", "dry-eye", and "stuffy head" were improved in the Active group.[ncbi.nlm.nih.gov]
Muscle Weakness
  • External or muscular asthenopia is due to extraocular muscle weakness and presents with dryness and irritation of the eyes. It is associated with nerve palsies, strabismus, glare from lights, flickering stimuli from computer displays, and dry eyes.[symptoma.com]
Blurred Vision
  • Furthermore, significant correlations were found between total nearwork time and blurred vision, and blurred vision and reduced accommodative facility.[ncbi.nlm.nih.gov]
  • Asthenopia encompasses all of the disorders and problems that arise in relation to looking at objects up close such as eye discomfort, blurred vision, sporadic double vision, premature tiredness, the inability to maintain a consistently clear image from[eyecos.eu]
  • The symptoms of eye strain are varied and might include: Headaches Blurred vision Light sensitivity Red, watery eyes Painful or sore eyes Dry eyes Tired eyes Back and neck aches Muscle spasms Most, if not all, symptoms of eye strain are easily remedied[specsavers.co.uk]
Strabismus
  • None of these participants had previously noticed symptoms of strabismus. Only the presence of strabismus was significantly different between the groups (P .008).[ncbi.nlm.nih.gov]
  • In the absence of ghosting to distinguish it from accomodative asthenopia should do a test on latent strabismus (with approximations of the object one eye given).[lecheniebolezni.com]
Esotropia
  • Again it was noted that when accommodation failed a right esotropia developed transiently. The negative fusional vergence was 12 prism dioptres base-in for near, and 4 prism dioptres base-in for distance.[bjo.bmj.com]
  • PURPOSE: This study was conducted to investigate the asthenopic symptoms in patients with exotropia and esotropia while watching stereoscopic 3D (S3D) television (TV).[ncbi.nlm.nih.gov]
  • This article briefly describes the more common diseases of the eye and its associated structures, the methods used in examination and diagnosis, and the… … Universalium Esotropia — Classification and external resources ICD 10 H50.0, H50.3 ICD 9 … Wikipedia[medicine.academic.ru]
Miosis
  • Note 2) Rate of miosis Seeing of close objects involves adjustment of lens thickness by the ciliary muscle and contraction of the pupil (miosis) by the pupillary sphincter muscle, which enable formation of a clear image.[lab-sunchlorella.com]
  • As convergence, accommodation and miosis occurs simultaneously as a near vision complex, the images with uncrossed disparity may not cause unnecessary accommodation and may reduce ocular asthenopia [ 23 ].[bmcophthalmol.biomedcentral.com]
Corneal Opacity
  • An ophthalmological examination is essential to evaluate tear film, corneal opacities, and refraction. Visual acuity test, cycloplegic refraction test, and fundoscopy must be performed in all cases of asthenopia.[symptoma.com]
Headache
  • Symptoms include pain in or around the eyes, headache, dimness of vision, dizziness, and slight nausea. as·the·no·pi·a ( as'thĕ-nō'pē-ă ) Subjective symptoms of ocular fatigue, discomfort, lacrimation, and headaches arising from use of the eyes.[medical-dictionary.thefreedictionary.com]
  • After watching S3D TV for 20 min, a survey of subjective symptoms was conducted with a questionnaire to evaluate the degree of S3D perception and asthenopic symptoms such as headache, dizziness and ocular fatigue while watching 3D TV.[ncbi.nlm.nih.gov]
  • It is accompanied by Headache and Weak Eye Sight.[herbpathy.com]
  • At times, the intensity of the headaches associated with asthenopia can be considerable and may even result in migraines with nausea and vomiting. B) Myopia.[eyecos.eu]
  • 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, and dimness of vision.[eyewiki.aao.org]
Dizziness
  • After watching S3D TV for 20 min, a survey of subjective symptoms was conducted with a questionnaire to evaluate the degree of S3D perception and asthenopic symptoms such as headache, dizziness and ocular fatigue while watching 3D TV.[ncbi.nlm.nih.gov]
  • Symptoms include pain in or around the eyes, headache, dimness of vision, dizziness, and slight nausea. as·the·no·pi·a ( as'thĕ-nō'pē-ă ) Subjective symptoms of ocular fatigue, discomfort, lacrimation, and headaches arising from use of the eyes.[medical-dictionary.thefreedictionary.com]
  • Individuals who have poor convergence, accommodation, and visual tracking abilities – all of which are necessary for single, clear and comfortable 3D viewing – may experience blurred vision, diplopia, dizziness and headaches when exposed to this type[mivision.com.au]
Vertigo
  • Muscular asthenopia: due to imbalance of the extraocular muscles Nervous asthenopia: due to functional or organize nervous disease Symptoms Pain in and around eyes Headache, usually aggravated by use of eyes for closework Fatigue Vertigo Reflex symptoms[eyewiki.aao.org]

Workup

Clinical presentation of asthenopia is similar to various other ocular disorders posing clinicians and optometrists with diagnostic challenges [3] [10]. Evaluation of patient's symptoms along with clinical measures helps to diagnose the condition and plan further management. The workup should start with a detailed history to elicit eyestrain at the college or work, refractive errors, use of spectacles or contact lenses, and previous laser surgery to correct refractive errors. An ophthalmological examination is essential to evaluate tear film, corneal opacities, and refraction. Visual acuity test, cycloplegic refraction test, and fundoscopy must be performed in all cases of asthenopia. The cover or patch test helps to confirm the diagnosis of asthenopia and differentiate between the two types of asthenopia. Persistence of symptoms after patching one eye for several hours indicates accommodative stress while relief of symptoms after resting one eye indicates muscular incompetence. Tests to differentiate accommodative insufficiency from ocular myasthenia gravis such as the Tensilon test, acetylcholine receptor antibody titers, and single fiber electromyography (EMG) testing can also be performed.

Laboratory and radiological studies are usually not indicated during the workup.

Treatment

  • Abstract The aim of this study was to describe the orthoptic and ophthalmological findings in schoolchildren with asthenopia, to correlate them with asthenopic symptoms and to evaluate the effect of treatment.[ncbi.nlm.nih.gov]
  • Fat and Blood An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria[wordnik.com]
  • All four groups underwent an eight week treatment. Group 2 and 3 received optometric/orthoptic treatment of their asthenopia. Group 1 and 4 received placebo treatment, i.e. a pair of plano or 0.25D glasses.[iovs.arvojournals.org]
  • Cooper, J, Duckman, R 1978 Convergence Insufficiency: Incidence, diagnosis, and treatment Am J Optom Assoc 49 673 9 Google Scholar 21.[link.springer.com]

Prognosis

  • What is the prognosis of eye strain? The symptom of eye strain does not result in any damage to the eyes. Therefore, the prognosis is excellent. Relief of eye strain symptoms will usually occur using the above techniques.[medicinenet.com]

Etiology

  • Etiology and pathogenesis ASTHENOPIA MUSCLE (ASTHENOPIA MUSCULARIS) Etiology. Dissociation between accommodation and convergence in myopia of medium degree (especially in the range of 3.0 - 6.0 D). The pathogenesis.[lecheniebolezni.com]
  • Etiology Accommodative asthenopia: strain of ciliary muscle and refractive error. Photogenous asthenopia: excessive or improper illumination.[eyewiki.aao.org]
  • […] may be referred to asthenopia, a visual disorder that reveals itself through eyestrain, fatigue, pain in or around the eyes, and blurred vision. 5 Aside from the association with jobs requiring intensive utilization of visual display terminals, its etiology[nature.com]
  • Importantly, the underlying etiology of eyestrain must be better understood.[reviewofoptometry.com]
  • This is frequently caused by a lack of appropriate cortical output that is necessary for accurate accommodative and fusional vergence system responses, and for the demands of the task. 1 As seen in figure 2, there are a number of etiologies for asthenopia[mivision.com.au]

Epidemiology

  • AIMS: To study the prevalence of asthenopia among computer operators and its association with various epidemiological factors.[ncbi.nlm.nih.gov]
  • Manuel AP Vilela, 1,2 Victor D Castagno, 2,3 Rodrigo D Meucci, 3,4 Anaclaudia G Fassa 3,4 1 Postdoctoral Program in Epidemiology, 2 Department of Specialized Medicine – Ophthalmology, 3 Doctoral Program in Epidemiology, 4 Department of Social Medicine[dovepress.com]
Sex distribution
Age distribution

Prevention

  • BACKGROUND: The objective of this study was to experimentally investigate whether a new visual intervention with optical and binocular vergence demands prevents accommodative insufficiency and asthenopia after sustained periods of visual task.[ncbi.nlm.nih.gov]
  • In the same way as a droplet of oil dropped into a cup, the oil layer forms a thin film to prevent heating of tears. The mucin layer fulfills the role of glue that adheres to the surface of the eye to prevent tears from running out of the eye.[seikoeyewear.com]

References

Article

  1. Bhanderi DJ, Choudhary S, Doshi VG. A community-based study of asthenopia in computer operators. Indian J Ophthalmol. 2008;56(1):51–55.
  2. Thorud HM, Helland M, Aarås A, et al. Eye-related pain induced by visually demanding computer work. Optom Vis Sci. 2012; 89(4): E452–E464.
  3. Sheedy JE. The physiology of eyestrain. J Mod Optics. 2007;54: 1333–1341.
  4. Grosvenor T. Primary care optometry. 5th ed. Philadelphia: Butterworth Heinemann Elsevier; 2007.
  5. Feldman F, Cooper J. Assessing the reliability and validity of an asthenopia questionnaire. American Optometric Association. http://avehjournal.org/index.php/aveh/article/viewFile/293/pdf_1. Accessed 08 Feb 2017.
  6. Sheedy JE, Hayes J, Engle J. Is all asthenopia the same? Optom Vis Sci. 2003;80:732–739.
  7. Pointer JS, Gilmartin B. Clinical characteristics of unilateral myopic anisometropia in a juvenile optometric practice population. Ophthalmic Physiol Opt. 2004;24(5):458–463.
  8. Ip JM, Robaei D, Rochtchina E, Mitchell P. Prevalence of eye disorders in young children with eyestrain complaints. Am J Ophthal. 2006;142:495–497.
  9. Alexander JA, Joyes D, Liew C, Omrod M, Wong A. A survey of cases in Sydney optometric practices: Age and sex distributions; symptoms and reasons for consultation. Aust J Optom. 1985;68:133–138.
  10. Scheiman M, Wick B. Clinical management of binocular vision: Heterophoric, accommodative and eye movement disorders. 3rd ed. Philadelphia, PA: JB Lippincott; 2008.

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Last updated: 2019-07-11 22:35