CIRCULATORY PROBLEMS OF THE AQUEOUS HUMOUR RESULTING FROM ON-SCREEN COMPUTER WORK.

A retrospective case series of 100 eyes in 58 patients experiencing significant discomfort during screen work, successfully treated with peripheral iridotomy.

HOSPITAL/PRIVATE PRACTICE

The series comprised 100 eyes from 58 patients: 38 women and 20 men, 50% with a family history of glaucoma, eight with GFA. The mean age was 54 years (21–82). The average refraction was +1.5 (-0.25–+8). 98 eyes were phacic and two were pseudophacic. All eyes wore appropriate correction. Average IOP was 15mm/Hg (10–34). Questioning revealed, in order of frequency, pain, ocular fatigue, visual discomfort, a feeling of pressure, scotomas, red eye, cramps, falling asleep while reading and itching on waking up in the morning.

The most common triggers were reading, working on-screen and any effort required for fixation of near vision.

Gonioscopy revealed scattered synechiae in 40 eyes (from 90 to 360°); an hidden trabeculum in 34 eyes; a closed angle in 24 eyes openable nonetheless from 90 to 270°; and two eyes with a wide open angle.

High-frequency mesopic echocardiography found an open angle in eight eyes; a very narrow angle in 24 eyes; a plateau iris in 20 eyes; incomplete angle closure in 44 eyes; and scattered synechiae in four eyes.

YAG laser iridotomy performed on the outermost periphery of the iris, on the appropriate meridian and guided by echo data, eliminated symptoms in all cases. There were two cases of dysphotopsia (PI at 12 o’clock and one at 3 o’clock) and one case of medically cured anterior uveitis.

Discussion: The range of symptoms encountered in this case series is identical to that seen in Uveitis-Glaucoma-Hyphema (UGH) Syndrome, linked to uveal and particularly ciliary irritation and attributable to the zonule and/or iris root being put under tension by the aqueous humour due to pupillary blockage.

The human eye has to deal nowadays with extended periods of fixation work focused on computer screens, which can lead to an imbalance in the tear film as well as circulatory problems of the aqueous humour. Accordingly, any patient reporting visual discomfort while working on-screen should undergo dynamic gonioscopy.