The use of electronic devices such as laptops, e-readers, computer tablets, and cell phones is integral to everyday life for most individuals. The 2015 Nielsen Report revealed that the average American, 18 years and older, spends more than 11 hours a day using some type of electronic device.1 In addition, a recent report by Common Sense Media, Inc, revealed that the average American teen spends more than 9 hours a day using an electronic device to access some type of media.2
With the increasing use of electronic devices, pharmacists are likely to encounter patients with digital eyestrain and headaches. Many patients may not be aware that these symptoms are often due to prolonged or improper use of electronic devices. Digital eyestrain and headaches are now common. According to the American Optometric Association (AOA), vision problems and headaches are reported by 70% to 75% of workers who use computers.3 In addition, results from a clinical trial show that 64% to 90% of computer users experience symptoms including eyestrain, headaches, ocular discomfort, dry eye, neck and back pain, diplopia, and blurred vision after prolonged use of computers or other electronic devices.4

According to the AOA, computer vision syndrome results from prolonged use of laptops, tablets, e-readers, and cell phones. Users may experience headaches, eye pain or watering, double vision, dry eye, loss of focus, and neck and shoulder pain.3 The symptoms associated with computer vision syndrome are often the result of poor lighting, glare from a digital screen, reading without pausing to rest the eyes, poor posture when using a device, improper viewing distance, and/or a combination of these factors.3,5 Pharmacists should be prepared to counsel patients regarding computer vision syndrome, suggest nonpharmacologic measures, and guide them on the proper use of OTC products that may alleviate common symptoms such as dry eyes and headaches (Online Table 1; Table 2).

Prevention and Treatment
Patients can employ a host of nonpharmacologic measures to prevent or reduce the incidence of computer vision syndrome symptoms.5,6

Table 1: Nonpharmacologic Measures to Prevent and Reduce Digital Eyestrain and Headaches, as well as Symptoms of Computer Vision Syndrome 
  • Adjust interior lighting, and the brightness and contrast of electronic devices to prevent glare on electronic screens.
  • To avoid headache and neck and/or back pain, position digital displays so that the head is in a naturally comfortable position while the device is being used.
  • Ensure the center of electronic devices is 20 to 28 inches from the eyes, and 4 to 5 inches below eye level.
  • Take frequent breaks and limit screen time to rest the eyes. Adjust body position when necessary.
  • Rest the eyes, at least every 20 minutes, by looking away from the device for at least 20 seconds. After 2 hours of continuous use of an electronic device, rest the eyes for at least 15 min.
  • Maintain correct posture to support the neck and back, and avoid neck and shoulder strain commonly associated with computer vision syndrome.
  • When warranted, use artificial tears to prevent or relieve dry eyes. In addition, blink often.
  • Have routine checkups with an eye doctor to monitor and maintain ophthalmic health.

Nonprescription Therapies
Individuals who experience mild-tomoderate episodes of dry eye due to computer vision syndrome may benefit from the use of artificial tear products (Online Table 3). Ocular lubricants, such as artificial tear solutions, contain preservatives and inorganic electrolytes meant to achieve tonicity and sustain pH, as well as water-soluble polymeric systems.7 Newer artificial tear products stabilize tear film, protect corneal and conjunctival cells, decrease tear evaporation with a combination of lipids, and enhance wound healing and lubrication of the ocular surface.7 Preservative-free products are also available. Studies have demonstrated that artificial tear products, without preservatives, are less likely to irritate the ocular surface compared with products with preservatives.7 Patients should be advised to adhere to manufacturers’ recommendations regarding the administration, storage, and shelf life of these products. These products typically contain enhancing agents, such as carboxymethylcellulose, glycerin, hydroxyethyl cellulose, hydroxypropyl methylcellulose, methylcellulose, polycarbophil, polyethylene glycol 400, polysorbate 80, and polyvinyl alcohol 1.4%.7

Table 3: Examples of OTC Ophthalmic Lubricants and Artificial Products
Artificial Tear Solutions
  • Bion Tears
  • Celluvisc
  • Dry Eyes
  • GenTeal Tears
  • HypoTears
  • Moisture Eyes
  • Murine Tears Lubricant
  • Nature’s Tears
  • Refresh Optive
  • Refresh Dry Eye
  • Refresh Liquigel
  • Refresh Plus
  • Refresh Tears
  • Soothe
  • Systane
  • Teargen
  • Tears Naturale
  • Visine Pure Tears
Nonmedicated Ointments
  • Artificial Tears PF
  • Dry Eyes
  • DuraTears Naturale
  • HypoTears
  • Lacrilube
  • LubriFresh PM
  • Moisture Eyes PM
  • Refresh PM
  • Tears Renewed -

In general, patients with mild cases of dry eye should instill artificial tears once or twice daily, typically in the morning and before bedtime. For more severe cases of dry eye, patients may be instructed to use these products at least 3 or 4 times a day, or as needed.7 Patients who do not experience relief should be encouraged to consult their primary health care provider. Patients should be reminded that artificial tear products containing preservatives may cause allergic reactions and should be immediately discontinued if a reaction occurs.7 To provide additional soothing comfort during instillation, artificial tear products can be refrigerated. Artificial tears are considered very safe and can be used as often as needed.7

Table 4: Examples of OTC Analgesics for Headaches
Active Ingredient Brand Name
Acetaminophen
  • Tylenol (Regular and Extra Strength)
  • Tylenol 8 Hour
  • Anacin
Aspirin
  • Bayer Rapid Headache Relief
  • Bufferin, Bufferin Extra Strength
  • Ecotrin
Ibuprofen
  • Advil
  • Advil PM
  • Motrin IB
Naproxen sodium
  • Aleve

Patients who experience occasional headaches and neck and back pain due to computer vision syndrome may benefit from the use of nonprescription analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs (ibuprofen and naproxen), and salicylates (aspirin, magnesium salicylate, and sodium salicylate) (Online Tables 4 and 5). These products are available in various formulations as singleentity or combination products, such as tablets, capsules, gel capsules, liquigels, enteric-coated tablets, extended- or sustained-release formulations, liquids, suspensions, effervescent tablets, rapidrelease gel capsules, powders, and chewable tablets. In addition, several alternative medications are marketed for the relief and management of headaches and neck and back pain.

Active Ingredients Brand Name
Acetaminophen, aspirin, caffeine
  • Anacin Advance Headache Formula
  • Excedrin ES
  • Goody's Extra Strength Headache Powder
  • Vanquish Extra Strength
  • Good Sense Added Strength Headache Relief
Aluminum hydroxide, aspirin calcium carbonate, magnesium hydroxide
  • Ascriptin Maximum Strength
Acetaminophen and caffeine
  • Excedrin Tension Headache
Aspirin, caffeine, salicylamide
  • BC Headache Powder

The Pharmacist’s Role
Prior to recommending OTC analgesics, pharmacists should always screen patients for potential allergies, contraindications, and drug–drug interactions. During counseling, patients should be educated about the proper use of analgesics, including the recommended duration of use, and be advised to take these products with food or milk if stomach upset occurs.8 Patients should also be advised of the potential adverse effects associated with the use of these products.

Although mild headaches, and neck and back pain often last only a few hours and can be easily managed, patients should be encouraged to seek further medical care if they do not obtain relief from using OTC analgesics, if they experience chronic headaches, or if headaches increase in intensity or frequency.8 Patients should also be reminded that excessive use of analgesics may lead to rebound headaches or medication overuse headaches.8

During counseling, pharmacists should remind patients who experience computer vision syndrome to incorporate various nonpharmacologic preventive measures into their daily routine, including taking breaks from using electronic devices.


Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References
  1. The Total Audience Report Q4 2014. The Nielsen Company website. nielsen.com/us/en/insights/reports/2015/the-total-audience-report-q4-2014.html. Accessed January 15, 2016.
  2. The common sense census: media use by tweens and teens. Common Sense Media, Inc, website. commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens. Accessed January 15, 2016.
  3. Computer vision syndrome. American Optometric Association website. aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome?sso=y. Accessed January 15, 2016.
  4. Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt. 2011;31:(5)502-515. doi: 10.1111/j.1475-1313.2011.00834.x.
  5. Computer vision syndrome. Bausch and Lomb website. bausch.com/your-eye-concerns/eye-infections-irritations/computer-vision-syndrome-computer vision syndrome#.Vpk0Klkt82w. Accessed January 15, 2016.
  6. Five fixes for computer vision syndrome. Cleveland Clinic website. health.clevelandclinic.org/2013/09/5-fixes-computer-vision-syndrome. Accessed January 15, 2016.
  7. Fiscella R, Jensen M. Ophthalmic Disorders. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 18th ed. Washington, DC: American Pharmacists Association; 2015.
  8. Wilkinson J. Headache. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 18th ed. Washington, DC: American Pharmacists Association; 2015.