
The Effects of Computer Use on Eye Health and Vision (1997) [pdf] - walterbell
https://www.aoa.org/Documents/optometrists/effects-of-computer-use.pdf
======
iambateman
While we’re here, lets do a quick eye-related work checklist:

1\. Monitor should be arms length away. 2\. Brightness should conform to the
light in the room. 3\. Try to get a good bit of ambient light from the side
(via a lamp or window). 4\. Keep eyes at a 10-15° downward angle on the
monitor. 5\. Take a break every hour and let your eyes rest for a second. 6\.
If you have glasses, wear them.

Those six principles will go a long way toward keeping your eyes happy!

~~~
EADGBE
> 6\. If you have glasses, wear them.

Is that for people who need glasses but don't wear them, or wear corrective
lenses (of some sort) all the time but really should use glasses because there
somehow better?

Seriously, I want to know, being the latter part.

~~~
p10_user
I think it’s the former. Not wearing corrective lenses (glasses or contacts)
when needed causes additional eye strain.

------
davesque
This document was published in 1997. I know it's anecdotal, but I've always
felt that staring at a cathode ray tube was decidedly more fatiguing than
staring at a flat panel. Is it just me or is there some sense to this?

~~~
matco11
As far as I know there are 4 causes of eye fatigue from CRTs: 1) constantly
looking at the same distance. This is the same with LCD and xLED displays, or
even paper books; 2) refresh rate 3) intensity of the light emitted (on its
own and compared to surrounding environment) 4) particles fired at your face
by the magnetic field generated by the CRT

As far as I know, cause 4) has the most impact, dust particles were literally
fired at your eyes, and for this reason 20 years ago it was relatively easy to
see people with grounded filters mounted to their CRTs (you used to attach the
ground wire to the ground contact of the RS232 or parallel port of the PC)

~~~
ValentineC
> _4) particles fired at your face by the magnetic field generated by the CRT_

> _As far as I know, cause 4) has the most impact, dust particles were
> literally fired at your eyes, and for this reason 20 years ago it was
> relatively easy to see people with grounded filters mounted to their CRTs
> (you used to attach the ground wire to the ground contact of the RS232 or
> parallel port of the PC)_

I've always wondered whether this actually worked, since I had the impression
that the grounding was BS and all those filters did was reduce glare.

------
userbinator
In 1997 the majority of monitors were CRTs, so lines were naturally fuzzy and
I think this is a large part of what causes eyestrain --- the inability to
focus clearly. I remember upgrading to an LCD and the sharpness was amazing. I
think widespread subpixel antialiasing later made things worse; when I first
tried it, the text looked "too smooth" and I got dizzy, watery eyes because it
felt like I constantly couldn't focus. Now I make it a habit of always turning
it off, and I suspect the studies that say it increases reading speed are
because for most people it subtly makes them want to _not_ stop and focus ---
it's subconsciously unpleasant to.

~~~
walterbell
Are there differences in subpixel antialiasing between Windows, Mac, Linux,
iOS, Android?

~~~
shurcooL
See this article on font rasterization [1] for a primer. The software used
makes a big difference.

[1]
[http://www.antigrain.com/research/font_rasterization/index.h...](http://www.antigrain.com/research/font_rasterization/index.html)

------
jibreel
I remember when i first started using the computer late into the night, around
3 am. that sure caused some problems, including floaters and astigmatism.

one factor people miss is that, it's not just the amount you spend staring at
screen that causes eyestrain and headache, but also how focused you are, we
squint a lot when we focus and that appearantly is an issue, looking at a
screen for 3 hours without having to think hard versus 1 hour of hard squint,
the 1 hour is more damaging. for me at least...

~~~
dragonsky67
I think the floaters are a function of both getting old, and brighter "white"
displays.

I started noticing them about 10 years ago when I got my first iMac. Prior to
that I'd mostly used smaller CRT displays, suddenly my field of view was taken
up by this big white screen and what were those dark shadows floating around
my view...

A few years on and I still see them, especially when using a 21+ inch screen
on white web pages. Just part of get old...

~~~
jacobolus
From what I understand accumulation of 'floaters' is common for most (all?)
people as they age, though some people surely have more problem with them than
others. I have never heard that looking at computer displays causes any
particular effect on the rate at which they develop.

------
briga
Have any of you people who work as software developers (or similar
professionals who spend most of their days looking at a screen) gotten Lasik
eye surgery? Have you noticed any regression in vision after the treatment as
a result of your screen usage?

~~~
walterbell
_disclaimer: not medical advice, please consult opthalmologist_

If you are nearsighted and wear your full _distance_ prescription for extended
_near_ (computer/reading) work, there is some chance that your eye will adapt
to the most dominant distance, eventually requiring a stronger prescription
for distance/driving. Rinse/repeat = ever worsening glasses for some people.

To avoid this problem, ask your optometerist for a separate (weaker)
prescription for computer glasses. You can get a ballpark idea from
[http://computerglassesrx.com](http://computerglassesrx.com). Glasses are
cheap these days, e.g. online from Zenni for less than $50.

Lasik carves a lens onto your eyes. If that lens strength is your _distance_
prescription, the same issue exists as with glasses. To reduce close-up strain
on your eyes, you can use plus lenses for close-up work, which reduces the
lasik/contacts "minus" prescription for near distances. Look at the calculator
above for an estimate, but consult an eye doctor, as there are variables like
age/presbyopia/convergence.

Previous HN thread on Lasik:
[https://news.ycombinator.com/item?id=9941566](https://news.ycombinator.com/item?id=9941566)

Non-mainstream discussion of plus lens therapy:
[http://forum.gettingstronger.org/index.php?topic=1115.0](http://forum.gettingstronger.org/index.php?topic=1115.0)

~~~
geowwy
Since getting some computer glasses my eyes have gone from deteriorating every
year to getting slightly better. Might be a coincidence but I suspect not.
Next time I'm in Asia I'm going to get an even weaker pair and see if my eyes
can keep improving.

~~~
walterbell
Cliff Hayes successfully went down that unsanctioned road, he published some
videos [1] and a PDF [2]. We need more scientific studies [3] to figure out
why undercorrection works for some people.

When it works, the key seems to be relaxing the eyes and surrounding muscles
while viewing objects at a distance which causes _just enough blur_. Within a
minute or two, the brain's visual cortex figures out a "software compensation"
for the signal coming from the eye, which lets the eye stay relaxed instead of
straining to focus. More info on Vision Therapy is available from behavioral
opthalmologists, but it takes time, motivation and may not be covered by
insurance.

[1] [https://youtube.com/user/cliffgnu](https://youtube.com/user/cliffgnu)

[2]
[https://drive.google.com/file/d/0B5REdzibAJQ4VFJuWnZCU3dLcHc...](https://drive.google.com/file/d/0B5REdzibAJQ4VFJuWnZCU3dLcHc/view)

[3] [https://dspace.mit.edu/openaccess-
disseminate/1721.1/105363](https://dspace.mit.edu/openaccess-
disseminate/1721.1/105363)

~~~
keypress
This is purely anecdotal. I have a bad astigmatism. I tend to not wear glasses
until I have to. In the garden I don't bother. And oddly, when I do use my
glasses everything becomes too much. In my mind scenery becomes unpleasantly
cluttered/dirty. It's quite horrible. I prefer the soft focus - but can't read
the laptop, watch TV without.

~~~
walterbell
If your astigmatism (cylinder) and/or spherical diopter numbers are very high,
your glasses may have significant distortion when looking through any point
other than the optical center of the lens, e.g. for peripheral vision. Have
you compared contacts with glasses? They provide a much wider field of view.

If you like soft focus, you can try on different drugstore reading glasses
(e.g. +0.50) over your normal glasses, to find a reduced strength which lets
you see at the desired distance without super-duper-sharp edges. Then ask your
optometrist to provide you with a reduced prescription for non-driving or near
work tasks. Otherwise, they will prescribe driving-strength glasses to avoid
legal liability.

~~~
keypress
Interesting, my prescription was out of range for contact lenses when last
explored. It might be worth me getting something as best as they can get if
the contact effect is beneficial.

~~~
walterbell
If your prescription is out of range for contacts, it means it is very weak,
so there shouldn't be much distortion in glasses, hence you won't see much
difference with contacts.

Easiest would be to find a friendly optometrist who will put your astigmatism
prescription into a trial frame, then let you self-adjust the cylinder and
axis values until you find your desired blend of clarity and softness _at your
target distance_. They can also advise on the safety of using that
prescription vs using no glasses.

------
Illniyar
As I understand it, and I think this study concurs, permanent eye damage isn't
caused by computer use.

Rather it's a combination of genetic susceptibility to being near/far sighted
and straining your eyes during the susceptibility "period".

That is if you aren't genetically inclined to eye problems, no reading or
computer use is going to make your require glasses. If you are genetically
inclined and do near work (reading books, computers,phones etc...) then your
number will rise during childhood and early adulthood. The number usually
stabilizes between 20 and 30 years.

If you are genetically inclined but don't do near work, you will not need
glasses.

Staring at a computer for long hours without blinking will give you headaches
though, and maybe blurry vision, but that'll pass in a day or two.

------
naiyt
I've had a lot of issues with dry eye, largely related to my computer usage.
(Although it's sort of a combination of 3 factors: I work on the computer, I'm
a T1 Diabetic, and I live in a dry climate. All contributors to dry eye.) At
times it was bad enough that I could barely read what was on the screen, or I
would leave the building and have to sit in my car for 5 or 10 minutes before
driving home because the sunlight was causing enough pain to keep my eyes
closed. It was impacting my life significantly.

Here's everything that I tried, along with a comment about how well it worked:

\- Switched from monthly contact lenses to dailies (Helped moderately, but at
that point my eyes were getting worse fast enough for me to not notice a real
difference

\- Switched from contact lenses to glasses (Helped with comfort once I got
used to glasses again, but not with dryness)

\- Various OTC eye drops (Retaine MGD is still the best for my eyes, but
overuse seems to make it worse)

\- Eye doctor prescribed a 2 week steroid eye drop regimen. (So no difference)

\- 10 minute warm compress on the eyes twice a day (This helped a lot when
done consistently, but my eyes were still really bad throughout the day)

\- Omega 3 supplements (Seemed to help a bit when I was consistent with the
dosage)

\- Various eye exercises (helps a lot, but I HAD to be consistent for multiple
days before seeing results)

\- Restasis (no benefit after 3 months)

\- Xiidra - okay, so this has given me the MOST relief out of anything, even
consistent eye exercises. My eyes actually feel normal again, and I saw
results after just a couple weeks. Using a new medication kind of makes me
nervous, and it's incredibly expensive (even with insurance), but I got to the
point where I was willing to take the risk because I was getting desperate.
Having severe dry eyes can negatively effect every waking moment.

I'm hoping that after a few more months on Xiidra my gland inflammation and
tear composition will be in a good enough place that I'll be able to stop
using the medication (which I'll be following up with my eye doctor about
soon).

If you're just getting started with a career on the computer START TAKING CARE
OF YOUR EYES NOW. Take frequent breaks and perform frequent eye exercises.
Hopefully that will help prevent you from getting to the place I did, where it
takes a significant amount of work and money to get back to having healthy
vision.

~~~
cgmg
Have you been diagnosed with meibomian gland dysfunction? Did you, by any
chance, ever take a drug called Accutane (Claravis/Amnesteem/isotretinoin)?

~~~
naiyt
Nope, never took Accutane. I got a full examination from a specialist
(including a LipiView analysis) and the conclusion was that I don't have MGD.
My glands look mostly fine, and my issues stem primarily from inflammation as
a result of the factors I mentioned (working on the computer, dry climate,
diabetes).

~~~
walterbell
Consumer Reports (Jan 2018) did not have a high opinion of dry eye
medications, [https://www.consumerreports.org/vision-eye-care/dry-eye-
symp...](https://www.consumerreports.org/vision-eye-care/dry-eye-symptoms-how-
to-handle/)

 _" However, both drugs are expensive and can cause side effects that can
worsen eye irritation and discomfort—Restasis in up to 17 percent of people
and Xiidra in up to 25 percent of people. "Judging from the clinical trials
data, the benefits of those two drugs are not that much more than the risk of
adverse effects,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical
adviser. “Their use should be relegated to a last-ditch measure, when all else
has failed.” _

Yawning can stimulate tear production:
[https://iristech.co/yawning/](https://iristech.co/yawning/)

~~~
naiyt
Believe me, I'm more than aware of the negative side effects and potential
dangers (especially with Xiidra, which is a new medication without long term
studies). Xiidra is costing me about $200 a month, after insurance. But in my
case it _was_ literally the last ditch measure, because I had tried everything
my ophthalmologist suggested as well as every "home remedy" out there. (When
you have severe dry eyes stuff like yawning is not going to help.)

For me, Xiidra has been the only thing that's given me relief. The side
effects have been fairly minimal (stinging for a minute or two, somewhat
blurry vision for up to 20 minutes) and my life is mostly back to normal now.
But the cost and lack of long term studies of the medication prevent me from
recommending it unless you and your ophthalmologist have determined that there
are no better options.

~~~
WillReplyfFood
Question: Can you still emit tears?

------
walterbell
Manual blinking can improve dry eyes caused by extended computer use:
[https://iristech.co/blink-detection/](https://iristech.co/blink-detection/)

 _" As we stare at the computer screen or while reading, our blinkrate
decreases. We actually blink 66% less while working on the computer. This can
make your eyes burn, dry out, turn red or feel itchy ... research demonstrates
that we do enter some sort of altered mental state when we blink — we’re not
just doing it to lubricate our eyes. A blink could provide a momentary island
of introspective calm in the ocean of visual stimuli that defines our lives."_

------
wallflower
If you haven't heard of the 20-20-20 rule, it is a simple rule-of-thumb to
remember to look 20 feet away for at least 20 seconds every 20 minutes.

Using a standup workstation during part of the day may also help you because
the "activation energy" required to move around and leave your workstation is
minimal compared to sitting in a chair.

You can also get a weaker prescription if you have eyeglasses (not sure about
contacts) that will help if you stare at a screen all day.

~~~
neves
20 is arbitrary, but it integrates finely with the Pomodoro Technique:
[https://cirillocompany.de/pages/pomodoro-
technique](https://cirillocompany.de/pages/pomodoro-technique)

~~~
walterbell
Any recommendations on physical (non-app) pomodoro timers?

~~~
wallflower
Just searching around. This may be a little too large but I like the
combination of visual and adjustable auditory indicators.

[https://www.timetimer.com/collections/timers/products/time-t...](https://www.timetimer.com/collections/timers/products/time-
timer-20min)

~~~
walterbell
Thanks for the pointer, that is a good combo.

UX of this multi-timer looks promising for tracking different classes of
activity, but I haven't tried it yet:
[https://www.amazon.com/gp/product/B004S56RJG/](https://www.amazon.com/gp/product/B004S56RJG/)

------
interfixus
One set of of anecdata from the suny end of the spectrum: I have been staring
at computer screens since 1982. For the first several years those screens were
mainly crappy small televisions attached to Orics and C64s. I was lucky to
have really good eyesight in '82, and I am lucky to have it still, although
these days, nearing sixty, I do need glasses for reading screens and paper. I
_can_ still manage without, but that ends in headache within just a few
minutes.

I buy those cheap standard supermarket glasses, currently at strength +2. They
get me nicely through 8 to 10 hours af screen in a day. Whenever I go off the
deep end, and spend more hours than that for several days running, I do tend
to get reddish, itchy eyes.

As others in the thread have reported, the arrival of flat screens was a
blessing. CRTs would generally tire me out quite a bit sooner. But I don't
seem to have suffered long term adverse effect from them.

~~~
mhandley
I'm the same. Also been staring at computer screens since 1982, with no
obvious problems. Getting old is annoying though: my arms are now not quite
long enough to focus perfectly on my phone screen without my reading glasses,
but a +1 pair of supermarket glasses is enough to fix that. Distance vision is
still fine.

The great thing about LCDs is that even in my 50s I can place them far enough
away to use without even needing reading glasses. CRTs were so bulky, it was
really hard to do that (but back then, I didn't need to).

Anyway, just another datapoint that intensive screen use for 3.5 decades
doesn't have to cause issues.

~~~
interfixus
> _a +1 pair of supermarket glasses_

+1? Those were the days!

------
Tade0
I've been staring at screens since I was 10 and always had perfect[0]
eyesight.

 _Had_ is the keyword here, because two years ago I began spending around half
of my time in a place 1500km away from my home, to and from which I drove,
because I needed to both have a flexible schedule and bring with me items that
I couldn't or didn't want to bring aboard a plane(like my guitar). Also I
despise flying.

After a year of those 17-20h drives back and forth I started experiencing
symptoms of dry eye syndrome which eventually developed into styes, and later
a total of three chalazions.

Recently I had a checkup done and while my left eye is still
good(insignificant defect), the one that had chalazions is currently -0.5D
with 0.25 astigmatism.

My point being: It took only two years of extremely long driving vs 17 years
of staring at screens to cause eye problems in my case.

[0] When I was 17 I could easily read time from a 30cm high LED display from
120m.

EDIT: emphasis.

~~~
walterbell
Did eye doctors have a theory for the connection between dry eye and driving?
How many breaks did you take during the 20h drive?

~~~
Tade0
My doctor said those chalazions are "no accident", but I'm not sure what she
meant by that.

I think it usually amounted to around five 15min breaks - mostly to buy
vignettes for each respective country I was driving through and to fill up.

After around 18,5h of driving I had to take naps in order to avoid falling
asleep at the wheel.

Needles to say I don't do those marathons anymore - it's obviously dangerous
and bad for my health. I break up this trip into two days which makes a world
of a difference.

------
TheAceOfHearts
Speaking of eye health, I wonder what effects programs like f.lux and their
newer built-in alternatives have. Despite a bit of trepidation when first
giving it a try, after a while it feels very natural.

Since ebook readers have become more commonplace in the last 20 years, I also
have to wonder what effects that might have on us. Even on days when I avoid
using my computer, I still spend a good couple of hours reading ebooks on a
tablet.

There have also been tons of advancements in technology. I don't think high-
DPI displays were commonly available, but the technology is increasingly
commonplace, especially on mobile devices.

~~~
tzs
Note that many tablets support things equivalent to f.lux. Apple tablets do, I
believe. So does Surface Pro and probably many other Windows based tablets
[1].

A lot of people claim that the Kindle Paperwhite does not need it because the
display is not back lit. (The lights are on the edge, and there is a
transparent light guide in front of the eInk display that directs this light
so that it shines on the eInk from the front and reflects off it to you).

This seems like complete bullshit to me, because I can not see any way that
the intrinsically photosensitive retinal ganglion cells in your eye could
possibly tell if photons come from a front lit display or a back lit display.
All they should care about is the wavelength and the intensity.

That's not to say that the claims that the Paperwhite doesn't need a reduced
blue light mode aren't true--I'm just saying that if they are true it isn't
because it is not back lit. It would be because they are using a light source
with less blue, or the eInk display absorbs blue so that it does not reflect
much blue from the light source.

Speaking of reducing blue light at night...I've wondered if what is important
is the absolute amount of blue light or the relative amount compared to
daytime levels. The intrinsically photosensitive retinal ganglion cells signal
the suprachiasmatic nucleus (SCN) in the brain with the amount of blue light
they are receiving. The SCN responds to changes in that to control circadian
rhythms.

If the SCN is just watching the levels and looking for them to cross certain
fixed thresholds, then at night we'd need to make sure we drop blue light
below certain absolute levels.

If, on the other hand, the SCN is looking for relative changes, such as blue
light dropping to below some percentage of the peak over the last 12 hours, or
over some kind of average over the last several hours, then instead of working
to eliminate blue light at night it should be possible to achieve the same
effects by _increasing_ blue light during the day.

So instead of trying to find software to reduce the blue light on every screen
in my house (an increasingly hard thing to do as more and more things have
screens), I should be able to install lights that have very high blue levels
and have them on during the day, to push the blue light threshold high enough
that when I turn those lights off I am below it even though my TV and other
screens do not have low blue light modes.

[1] Windows in general supports it, but I believe it requires some support
from the GPU, so whether or not it works on a particular tablet depends on the
hardware.

~~~
walterbell
This page links to research on blue light effects,
[https://glarminy.com/2016/04/11/are-your-eyes-sensitive-
to-l...](https://glarminy.com/2016/04/11/are-your-eyes-sensitive-to-light-or-
blue-light/)

------
feelandcoffee
I wonder how many of this have change with now monitors being LCD LED, CCFL or
even OLED instead of the traditional CRT. Specially in the "Radiation Emitted"
department.

------
tuxidomasx
"Although some of these problems may not result in symptoms under less
visually demanding conditions, the high demands of computer work cause them to
become manifest. "

THIS. After about 7 years of staring at a screen all day at work, then coming
home and staring at a screen all night (gaming, programing, etc), plus
marijuana = dry squinty eyes-- the cumulative effect was that my eyes began to
always focus slowly and unevenly, especially on things far away.

I got glasses and they helped, but it felt like more of a bandaid than a
solution.

I have since reduced my close-up computer screen usage dramatically. I also do
the occasional eye exercises (youtube has a lot of these and they really
help).

I stopped wearing glasses and spend more time outside and away from the screen
so my eyes actually have more things to do than look at bright pixels 3 feet
away.

If I could give any advice to my younger self it would be to minimize long
stretches of staring at the screen. Take plenty of breaks to give your eyes a
break.

------
watertom
What worries me the most is the fact that monitors and phones are outputting
light directly to our eyes. Almost everyone, at least in the U.S. has both
computers and phones and those devices output light directly to our eyes.
Where as, even in 1997 most people weren't spending all of their time looking
into light. We were looking at things with reflected light.

Somehow I think this direct light into our eyes is impacting our not only our
eyes, but our brains negatively.

------
m3kw9
I always adjust to the minumum brightness needed for my eyes to see can See
comfortably. The monitors and phones have a very bright default value, on my
LCD I practically have contrast and brightness near 0. Same with my phone.
Everyone is different, but I would adjust the brightness to match the exterior
lighting so they balance. Most people have the screen too high in comparison
to the background lights.

------
alborzmassah
Been using computers for 21 years. I got some floaters when I was a teenager,
but still 20/20!

~~~
delinka
"Got some"? My ophthalmologist says that everyone has them. Some of us are
just 'lucky' enough to notice they exist.

------
coldfire
Personally for me, I have got more back/shoulder problems from long term
computer usage than eye primarily due to bad posture. Though I do wear
glasses, but my prescription hasn't changed in the last ~10 years.

------
hellbanner
[https://theatrehouse.com/products/832-roscolene-rose-
pink](https://theatrehouse.com/products/832-roscolene-rose-pink) makes the
light less harsh

~~~
walterbell
Do you know the color temperature of that film, e.g. how does it compare to
using flux, redshift, etc?

~~~
hellbanner
I'm not an optics expert. I have used Flux and haven't used Redshift.

I much prefer the Rose screen to Flux. Flux changes the colors but, sorry I
lack the English to articulate this properly, the screen makes all light less
"harsh". This is most visible when looking at a white background. Even with
Flux on the rose tinted is much "softer" and easier to look at than the same
screen without.

FWIW, a neurologist recommended the screen to counteract excessive optical
stimulation from computer use.

I've stopped using Flux in favor of this screen, even at night.

------
dryeye
I'm in my 20s and I have dry eye and it has significantly affected my life. I
wish I had known about it when I was younger.

Some background: eyes are lubricated by the tear firm which consists of three
layers: inner mucous layer, an aqueous solution layer, and an outer lipid
layer (meibum). The mucous layer is the thinnest and keeps the tear film to
your eye. The aqueous solution is released from the lacrimal gland and makes
up the bulk of the tear film. Meibum is secreted from meibomian glands in the
eyelids every time you blink and keeps the tear film from evaporating. With a
healthy tear film you should be able to keep your eyes open for at least 30
seconds before you start feeling a burning sensation. If you don't have a
stable tear film you will start to feel a burning sensation much sooner and
this is what is known as "dry eye". Dry eye and can be caused by a deficiency
in any of the three layers and is usually categorized into two main
categories: aqueous-deficient dry eye and evaporate dry eye. Aqueous-
deficiency dry eye is usually caused by systemic diseases such as autoimmune
diseases (e.g. rosacea, lupus, Sjogren's syndrome) that prevent the lacrimal
gland from producing tears and from the statistics that I've seen this
accounts for about 20% of dry eye cases. Evaporate dry eye is caused by a
deficient lipid layer which is usually caused by meibomian gland dysfunction
and accounts for the majority of dry eye cases.

There's not a lot known about what causes meibomian glands to malfunction but
some theories are that: inflammation causes them to get blocked, autoimmune
diseases attack the tissues, hormone imbalance causes deficient secretions,
harsh environments cause inflammation which causes them to get blocked, and
contact lenses interferes with blinking rates and the mechanics of blinking.
Once meibomian gland dysfunction starts, it often starts a vicious cycle which
causes inflammation which causes more blockages which causes more
inflammation. Blockage of the meibomian glands eventually (think several
years) leads to meibomian gland atrophy where the glands start shriveling up
and die, starting from the back. Healthy glands are normally about 10 mm long
but over time they will become truncated and eventually completely atrophy
(known as "gland drop out"). This process is also seen to a lesser degree in
elderly people, and especially postmenopausal women.

I started wearing contact lenses when I was a young teenager, and also as a
young teenager, I spend an unhealthy amount of time staring at computer
screens. A few years later my contact lenses started to become uncomfortable
and I switched contact lens brands and cleaning solutions and I was able to
continue wearing them for another couple of years. Eventually it got to the
point where I couldn't tolerate wearing them because they were just too
uncomfortable. I figured this was normal because lots of people complain about
their contact lens comfort, and I attributed it to living in a dry climate and
spending lots of time on the computer. But then, even with wearing glasses I
started noticing that my eyes were uncomfortable. I started waking up with
red, gritty eyes. I went to my optometrist and told him about this and he
simply gave me some eye drops and told me to put them in before bed and
whenever I felt dry eyes. But over the years problem only got worse. I had to
constantly blink, and my eyes were always bloodshot. This is when I started to
seriously investigate dry eyes.

I went to an optometrist seeking for help who told me about some things I
could try such as warm compresses (which I was already doing) and blinking
exercises. I also went to an ophthalmologist who basically told me that lots
of people have dry eye and bluntly told me "I deal with people who are about
to lose their eyesight, and you are not going to lose your eyesight because of
this" and prescribed me a short course of corticosteroid drops. I saw a couple
more optometrists who were of no help, before I decided to seek a dry eye
specialist in another city, who looked at my meibomian glands and confirmed
what I feared the worst: my meibomian glands were in very bad health. I was
only in my 20s, and my meibomian glands had already truncated to about 25% of
their original length. (You can see how healthy glands are supposed to look
compared to unhealthy, truncated glands:
[http://www.clemsoneye.com/Portals/0/meibomian_glands.png](http://www.clemsoneye.com/Portals/0/meibomian_glands.png))

I found a supportive optometrist in my city who is sympathetic and willing to
try different treatments with me. So far I have tried the following:

* Lubricating eye drops: I take preservative-free drops every day but they only offer limited short term relief. I've also tried lubricating gels but I find that they clog my glands even more and cause more discomfort. I only use them in emergencies when I'm willing to trade off short term comfort for more misery (they will unbalance up my tear film for several days).

* Warm compresses: Applies heat to your eyelids to unclog the glands. I do this once every few days but if I do it any more I will end up with more inflammation which makes my symptoms worse.

* Corticosteroids: They do seem to reduce inflammation but doctors won't prescribe these for more than a few weeks at a time because they cause high intraocular pressure.

* Tetracycline antiobiotics: Low dose tetracycline antibiotics (usually doxycycline, minocycline) are taken off-label to reduce inflammation. I've been taking these on and off for months at a time for the last 5 years. I believe it helps my comfort but my optometrist warns me to not stay on long term, but I will continue taking these for the rest of my life because at this point I don't care if long-term antiboitic use destroys my kidneys and liver.

* Restasis: An eyedrop that helps primary for aqueous-deficient dry eye. I've been on this for a while as well and I will continue to take it even thought I don't think it helps much. It's normally very expensive but luckily my insurance covers it.

* Lipiflow: A treatment where a machine places a cup on your eyeball and applies heat and massages the inside of your eyelids. I spent $1500 out of pocket on this and it was just as effective as my next item.

* Manual expressions: Using forceps my optometrist squeezes my eyelids to force meibum out of my glands to keep it from clogging and stagnating. This helps short term, but it can only be done so frequently because it can cause long-term tissue damage. I purchased my own forceps and (probably to the horror of my optometrist, I never told him) I do this myself.

* Controlling environment: Having a humidifier helps me a lot and I keep the relative humidity above 80%. Being in a dry environment such as airplanes is very uncomfortable and whacks my tear film out of balance for days.

* Moisture chambers: Essentially, these are air-tight goggles that prevent moisture from evaporating from your eyes. They do help but I hate having to wear them and I don't wear them in public, but I will probably have to eventually.

* Eye exercises: I consciously blink hard several times, every 30 minutes. It helps a bit.

Overall, my symptoms have only marginally improved. My life has become
miserable because of this and my social life and professional life have
suffered. I don't enjoy going out anymore because I hate being in dry
environments where it causes my symptoms to get worse. Just being in a dry
environment for a couple hours will disrupt my tear film for days after. It
has caused me depression and I considered ending my life at one point.

There is a lot unknown about this disease. Nobody can tell me why my glands
got into such bad shape, but I believe wearing contact lenses and using the
computer, and having bad blinking hygiene contributed a lot to it and I see
that even most optometrists have been clueless and are only now learning about
dry eye because of its increasing prevalence. Because it's not understood
well, there's not much support for sufferers of dry eyes. The immediate
reaction of optometrists upon hearing a complaint about dry eye is "here, try
this brand of sample drops that they sent to my clinic". Insurance doesn't
cover treatments and I've incurred thousands of dollars in out-of-pocket
expenses, and had to take significant time off from work to seek specialists
and treatments.

Looking back, here's what I wish I had done:

* Not wear contact lenses, especially when on the computer for 12+ hours a day

* Blink regularly and consciously when using a computer

* Investigated sooner about dry eye when I started experiencing symptoms (it is not normal to have dry eye)

* Spend more time outside

Perhaps how previous generations were taught about oral hygiene and the
importance of brushing teeth, future generations will be taught about ocular
hygiene and the importance of blinking exercises and health of eyelids.

~~~
walterbell
Previous thread mentioned (a) gel drops (b) googles with airtight seal to
reduce evaporation (c) taping eyes shut during sleep to reduce evaporation and
(d) discussion forum for dry eyes,
[http://www.dryeyezone.com/talk/](http://www.dryeyezone.com/talk/)

[https://news.ycombinator.com/item?id=7480946](https://news.ycombinator.com/item?id=7480946)

Yawning might help,
[https://youtube.com/watch?v=I0dQx4SNSwE](https://youtube.com/watch?v=I0dQx4SNSwE)

If the monitor is lower so that you are looking down, more of the eyes will be
covered by the eyelid, reducing evaporation.

