Now that you have read this far, try pausing for a moment and notice your chin. Many people will find it jutting forward, with their eyes squinting at small text. The eyes feel dry and stinging, and the head keeps inching toward the screen as if pulling it a few centimeters closer would make the words clearer. Nobody does this on purpose. Meanwhile the back of the neck grows stiff, and the area between the shoulder blades feels tired and burning.
Eyes tired from close work all day
When you look at something close, your eyes have to do two jobs at once: a small muscle inside the eyeball contracts to adjust the focus (accommodation), and the two eyes turn inward to look at the same point (convergence). A screen makes both jobs run nonstop for hours, while a person staring intently also tends to blink less often.
The review by Sheppard and Wolffsohn (2018) calls this digital eye strain and estimates that it affects half or more of computer users. One group of symptoms comes from strain on focusing and on the coordination of the two eyes, such as aching around the eye sockets, or vision that blurs briefly when you look away from the screen. The other group comes from dry eyes, with a gritty, burning feeling.
The head inches forward, and the neck and upper back carry more
When the head sits straight on top of the spine, the bones do most of the supporting. Move it a few centimeters forward, and the neck and shoulder muscles have to pull to hold it, just as holding a dumbbell out at arm’s length tires you faster than hugging it to your chest. The shoulders slump along with it, the chest muscles shorten, and the muscles between the shoulder blades are stretched yet still have to brace.
Pooling 15 studies, Mahmoud and colleagues (2019) found that adults with neck pain had a more forward head posture than those without pain, and the further forward the head, the worse the neck pain and the more daily activities were limited. These studies only captured a single point in time, so they cannot yet say which causes which.
Glasses with the wrong prescription, or a habit of holding your phone low in front of your stomach, also pull the head forward in the same way. Choosing a chair and changing your sitting position during the day are covered in our article on sitting in the right posture at work. If your neck and shoulders hurt even on days when you don’t touch a computer, the root may lie elsewhere, and our article on persistent neck and shoulder pain goes deeper into that situation.
Fix the eyes first, then the desk
People over forty often run into this: reading glasses are measured for the distance of a printed page, but the screen sits farther away, so they have to lean forward. Among the measures Sheppard and Wolffsohn list, correcting refractive errors and presbyopia comes first, followed by treating dry eyes, while blue-light filtering lenses give inconsistent results. When you go for an eye test, mention how far from the screen you usually sit.
At your desk, put the screen straight in front of you, with its top edge level with or slightly below eye level. If the text is small, zoom in on the computer instead of leaning forward. If you use a laptop all day, raise it up and attach a separate keyboard. Desk lamps and windows are best placed to the side, so they don’t dazzle your eyes or cast glare on the screen.
How often to rest your eyes
The 20-20-20 rule tells computer users to rest their eyes on a fixed rhythm. Every 20 minutes, look at something about 6 meters away for 20 seconds. These numbers are quoted everywhere, yet there is little evidence for them published in peer-reviewed journals. To test this, Johnson and Rosenfield (2023) had 30 young people read on a tablet for 40 minutes straight, in some sessions taking breaks on one of several schedules, in others reading without a break. Symptoms increased after every reading session, and the break schedules made no difference.
A small study of 30 young people like this has not shown a particular benefit from a scheduled 20-second break. If you still rest your eyes, tying each break to a real task makes it easier to keep up, such as looking out of the window after sending an email, or getting up to pour some water. When you stand up, your neck and upper back also get a change of position.
Changes in the eyes that need an exam right away
Sudden blurred vision, seeing double, seeing flashes of light or what looks like a curtain covering part of your vision, a red eye with aching pain, or a headache with nausea and halos around lights are times to see an eye doctor right away. These signs need the eye doctor’s instruments and slit lamp; muscle testing can wait. A headache that gets worse week by week also needs to be checked early.
When the screen is fixed but the neck still hurts
Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine) will ask how many screens you use, where they are placed, what glasses you wear for work, and when your eyes were last tested. The doctor watches you sit the way you do at work, then examines your neck and shoulders and the reflexes in both arms.
The distinctive part is checking whether the eyes and the neck are working together smoothly. The doctor chooses a muscle that tests strong during muscle testing, then asks you to move your eyes up, down, to the left and to the right. If the muscle clearly weakens when you look in a certain direction, Applied Kinesiology calls this an ocular lock, a sign that the nervous system is not yet matching the signals from the eyes with the position of the head and neck. A person with this may have already adjusted the screen and still have a tense neck, because every time the eyes move between two screens or look down at the keyboard, the neck muscles have to compensate again.
When there is an ocular lock, the doctor uses an Applied Kinesiology correction technique at the area of the Shufu point (K27) just below the collarbone, and on the upper part of the neck if the examination shows that section needs mobilizing. This procedure is part of AK technique. The doctor follows how far the eyes and neck have come back into coordination over a few visits. Applied Kinesiology also notes that a few muscles of the back are linked with vitamin A, but supplementing is only discussed after the doctor has done muscle testing, and you should not buy high-dose vitamin A and take it on your own, because long-term use can cause poisoning.
Traditional medicine holds that the eyes see clearly only when they are nourished by the blood of the Liver. So when someone has tired eyes together with dry eyes, blurred vision, pale fingernails and a lot of dreaming during sleep, the doctor thinks of a Liver blood deficiency pattern (肝血虚 / 肝血虛, gān xuè xū) and prescribes an herbal decoction that nourishes the blood, tailored to that person.
When the back of the neck and the shoulders have been stiff for a long time, acupuncture at points around the neck and shoulders is added. There are also a few exercises for the deep neck muscles and the muscles between the shoulder blades that you can do yourself right while sitting at work.
Worth keeping
- The next time you have your eyes tested, say clearly how far from the screen you usually sit;
- If you catch yourself leaning forward to read, zoom in on the text first and adjust your chair second;
- Tie each eye break to a real task, such as pouring water or fetching papers;
- If you use two screens, put the one you look at most directly in front of you;
- If your glasses and screen have been adjusted for a few weeks and the back of your neck is still tired, get checked further.
If you are pregnant or trying to conceive, do not take high-dose vitamin A on your own; ask your doctor first.
References
- Sheppard AL, Wolffsohn JS (2018). Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 3(1):e000146. https://doi.org/10.1136/bmjophth-2018-000146
- Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG (2019). The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med 12(4):562-577. https://doi.org/10.1007/s12178-019-09594-y
- Johnson S, Rosenfield M (2023). 20-20-20 Rule: Are These Numbers Justified? Optom Vis Sci 100(1):52-56. https://doi.org/10.1097/OPX.0000000000001971
