Some patients — particularly those with acne rosatia, poor diet,or menopause — have evaporative dry eye syndrome which accentuates dry eyes with computer use. These patients often still can have laser eye surgery with pre-treatment of their dry eye.
A patient from Santa Barbara came for a LASIK evaluation today. She told me she her eyes got tired and gritty feeling when she used the computer for a long time. She wanted to know how this would affect having LASIK.
When someone has fluctuating vision or their eyes burn, feel tired and irritated only when using the computer, this almost always is a sign of a particular form of dry eye called evaporative dry eye. In evaporative dry eye, the tears are unable to stay on the eye sufficiently, but instead evaporate away too soon, making the eye dry. Staring at the computer means there is less blinking going on, giving the tears the opportunity to evaporate, causing the surface of the eye (the cornea) to dry out. This, in turn, can cause irritation, blurry vision,and fluctuations in vision with computer use.
It turns out that dry eye is a very complex subject. There are two main categories of dry eye: poor tear quantity and poor tear quality. Patients with evaporative dry eye typically have poor tear quality. It turns out that the tears are made of a complex and exact recipe. Tears have three layers: a protein (mucous) layer on the bottom, a water (aqueous) layer in the middle, and an oil (lipid) layer on the top. The job of the oil in the tears is to float to the top of the tears and act as a lid to prevent evaporation. Patients with evaporative dry eye typically have a deficiency in the oil layer of the tears. This oil layer problem in the tears can be due to certain skin conditions such as acne rosacea, to poor diet, to menopause, or just to genetic reasons.
Computers seem to be the most important problem for people with dry eyes as they uniquely invite prolonged staring. Studies show that we typically blink every seven seconds if we are sitting in a room having a conversation. However, a video study from Japan once showed that computer users at work in their cubicles often went up to three minutes without blinking! If someone has a tendency toward evaporative dry eye, then this long period of not blinking allows the tears to evaporate off the surface of the eye, producing vision fluctuation, burning, tearing, and eye fatigue.
Many patients with symptoms like the patient from Santa Barbara I mentioned at the start of this blog still can successfully have LASIK or PRK if their evaporative dry eye is treated appropriately and brought under control before their laser eye surgery. Treatment can include oral omega three (both fish oil and flax seed oil), CSL or IPL skin treatment for rosacea, topical Restasis and Azasite eye drops, over the counter oily lubricant drops such as Systane Balance which replenish the oil layer, and even a procedure called LipiFlow. Often these treatments take time to work. However, with these treatments, many patients notice significant improvement in their evaporative dry eye symptoms and then can have LASIK or PRK laser vision correction with excellent results. Often, however, the dry eye treatments need to be maintained indefinitely — whether or not the patient has the laser eye surgery — as the underlying evaporative dry eye condition often only can be controlled rather than cured. Certainly, though, I have performed surgery on hundreds of such patients with very good outcomes.
See Also
Computer Eye Strain: 10 Steps for Relief
All About Vision discussion of improving eye comfort with computer use.
Dry Eyes: Causes and Treatment of Dry Eyes
WebMD discussion of dry eye causes and treatments.
Dry Eye
American Optometric Association page on dry eye.
Facts About Dry Eye
National Institutes of Health and National Eye Institute resource for understanding dry eye syndrome.
What Is Dry Eye?
American Academy of Ophthalmology EyeSmart discussion of dry eye for the general public.
Computer Vision Syndrome: A Review
A discussion in the medical literature about eye symptoms associated with computer use.