Digital Eye Strain in Esports Athletes: Blink Suppression, Ocular-Surface Symptoms, and Binocular Vision Findings - A Narrative Review

Oliwia Dziewięcka; Wojciech Ziębka; Julia Mądrzak; Bartłomiej Markowski; Magdalena Iwaszko; Julia Stojko; Marcelina Skajewska; Wojciech Kwieciński; Julia Kaczmarek; Julia Kujawa; Nela Poznańska

doi:10.12775/QS.2026.71.75062

Authors

Oliwia Dziewięcka A. Falkiewicz Specialist Hospital in Wroclaw, Poland https://orcid.org/0009-0008-7784-1680
Wojciech Ziębka A. Falkiewicz Specialist Hospital in Wroclaw, Poland https://orcid.org/0009-0000-6835-6773
Julia Mądrzak Faculty of Medicine, Kazimierz Pułaski University of Radom, Radom, Poland https://orcid.org/0009-0007-3387-9225
Bartłomiej Markowski Medical University of Lodz, Poland https://orcid.org/0009-0006-2538-9907
Magdalena Iwaszko Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland https://orcid.org/0009-0000-6010-5443
Julia Stojko Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland https://orcid.org/0009-0000-7724-1599
Marcelina Skajewska Jan Biziel University Hospital No.2 in Bydgoszcz, Poland https://orcid.org/0009-0009-5029-192X
Wojciech Kwieciński Independent Public Healthcare Centre in Szamotuly, Poland https://orcid.org/0009-0004-2891-6974
Julia Kaczmarek Independent Public Healthcare Institution MSWiA in Lodz, Poland https://orcid.org/0009-0006-3781-3066
Julia Kujawa St. Vincent de Paul Hospital in Gdynia, Poland https://orcid.org/0009-0003-2502-8552
Nela Poznańska Medical University of Lodz, Poland https://orcid.org/0009-0000-0326-7534

DOI:

https://doi.org/10.12775/QS.2026.71.75062

Keywords

digital eye strain, computer vision syndrome, esports, competitive gaming, cular surface, binocular vision

Abstract

Background. Competitive esports requires prolonged near-screen viewing and sustained visual attention, making digital eye strain (DES) clinically relevant to players.

Aim. To synthesize direct evidence from esports and gaming-task studies with clearly labeled indirect evidence on symptoms, blinking, the ocular surface, accommodation, vergence, risk modifiers, clinical assessment, and management.

Material and methods. This focused narrative review integrated publications from 2015 through 1 July 2026, including direct esports and gaming-task studies and clearly identified indirect evidence from other screen-user populations. Interpretation considered study design, population, outcomes, directness, and limitations.

Results. Direct esports and gaming-task studies support acute worsening of symptoms, task-related blink suppression, and selected short-term or cross-sectional differences in near-vision measures. Evidence of chronic ocular disease, irreversible injury, or effects on competitive performance remains insufficient. Symptoms, objective ocular signs, and dry eye disease are distinct outcomes.

Conclusions. Assessment should be symptom-led and should address ocular-surface, refractive, binocular, and ergonomic contributors. Breaks and ergonomic adjustments are reasonable low-risk measures, but blue-light-filtering lenses and the exact 20-20-20 schedule should not be presented as proven treatments.

References

[1] Kaur K, Gurnani B, Nayak S, Deori N, Kaur S, Jethani J, et al. Digital eye strain—A comprehensive review. Ophthalmol Ther. 2022;11(5):1655-1680. https://doi.org/10.1007/s40123-022-00540-9.

[2] Anbesu EW, Lema AK. Prevalence of computer vision syndrome: a systematic review and meta-analysis. Sci Rep. 2023;13:1801. https://doi.org/10.1038/s41598-023-28750-6.

[3] Ccami-Bernal F, Soriano-Moreno DR, Romero-Robles MA, Barriga-Chambi F, Tuco KG, Castro-Diaz SD, et al. Prevalence of computer vision syndrome: a systematic review and meta-analysis. J Optom. 2024;17(1):100482. https://doi.org/10.1016/j.optom.2023.100482.

[4] Ranasinghe P, Wathurapatha WS, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, et al. Computer vision syndrome among computer office workers in a developing country: an evaluation of prevalence and risk factors. BMC Res Notes. 2016;9:150. https://doi.org/10.1186/s13104-016-1962-1.

[5] Dessie A, Adane F, Nega A, Wami SD, Chercos DH. Computer vision syndrome and associated factors among computer users in Debre Tabor Town, Northwest Ethiopia. J Environ Public Health. 2018;2018:4107590. https://doi.org/10.1155/2018/4107590.

[6] Pucker AD, Kerr AM, Sanderson J, Lievens C. Digital eye strain: updated perspectives. Clin Optom (Auckl). 2024;16:233-246. https://doi.org/10.2147/OPTO.S412382.

[7] DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport Exerc Med. 2019;5:e000467. https://doi.org/10.1136/bmjsem-2018-000467.

[8] Chaiwiang N, Koo-Akarakul J. Digital challenges: investigating computer vision syndrome in Thai esports through a case-control approach. Clin Optom (Auckl). 2024;16:201-210. https://doi.org/10.2147/OPTO.S460868.

[9] Mi Y, Zhao S, Ju F. An integrated health management model to improve the health of professional e-sports athletes: a literature review. PeerJ. 2025;13:e19323. https://doi.org/10.7717/peerj.19323.

[10] Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018;3:e000146. https://doi.org/10.1136/bmjophth-2018-000146.

[11] Mylona I, Glynatsis MN, Floros GD, Kandarakis S. Spotlight on digital eye strain. Clin Optom (Auckl). 2023;15:29-36. https://doi.org/10.2147/OPTO.S389114.

[12] Wolffsohn JS, Lingham G, Downie LE, Huntjens B, Inomata T, Jivraj S, et al. TFOS Lifestyle: impact of the digital environment on the ocular surface. Ocul Surf. 2023;28:213-252. https://doi.org/10.1016/j.jtos.2023.04.004.

[13] Cantó-Sancho N, Porru S, Casati S, Ronda E, Seguí-Crespo M, Carta A. Prevalence and risk factors of computer vision syndrome—assessed in office workers by a validated questionnaire. PeerJ. 2023;11:e14937. https://doi.org/10.7717/peerj.14937.

[14] Seguí MdM, Cabrero-García J, Crespo A, Verdú J, Ronda E. A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol. 2015;68(6):662-673. https://doi.org/10.1016/j.jclinepi.2015.01.015.

[15] Perez VL, Chen W, Craig JP, Dogru M, Jones L, Stapleton F, et al. TFOS DEWS III: executive summary. Am J Ophthalmol. 2026;282:135-145. https://doi.org/10.1016/j.ajo.2025.09.035.

[16] Moon JH, Kim KW, Moon NJ. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case-control study. BMC Ophthalmol. 2016;16:188. https://doi.org/10.1186/s12886-016-0364-4.

[17] Rossoni A, Vecchiato M, Brugin E, Tranchita E, Adami PE, Bartesaghi M, et al. The eSports medicine: pre-participation screening and injuries management—an update. Sports (Basel). 2023;11(2):34. https://doi.org/10.3390/sports11020034.

[18] Zwibel H, DiFrancisco-Donoghue J, DeFeo A, Yao S. An osteopathic physician’s approach to the esports athlete. J Am Osteopath Assoc. 2019;119(11):756-762. https://doi.org/10.7556/jaoa.2019.125.

[19] Lee JW, Cho HG, Moon BY, Kim SY, Yu DS. Effects of prolonged continuous computer gaming on physical and ocular symptoms and binocular vision functions in young healthy individuals. PeerJ. 2019;7:e7050. https://doi.org/10.7717/peerj.7050.

[20] Chidi-Egboka NC, Jalbert I, Golebiowski B. Smartphone gaming induces dry eye symptoms and reduces blinking in school-aged children. Eye (Lond). 2023;37(7):1342-1349. https://doi.org/10.1038/s41433-022-02122-2.

[21] Kim DJ, Lim CY, Gu N, Park CY. Visual fatigue induced by viewing a tablet computer with a high-resolution display. Korean J Ophthalmol. 2017;31(5):388-393. https://doi.org/10.3341/kjo.2016.0095.

[22] Al-Mohtaseb Z, Schachter S, Lee BS, Garlich J, Trattler W. The relationship between dry eye disease and digital screen use. Clin Ophthalmol. 2021;15:3811-3820. https://doi.org/10.2147/OPTH.S321591.

[23] Kamøy B, Magno M, Nøland ST, Moe MC, Petrovski G, Vehof J, et al. Video display terminal use and dry eye: preventive measures and future perspectives. Acta Ophthalmol. 2022;100(7):723-739. https://doi.org/10.1111/aos.15105.

[24] Parihar JKS, Jain VK, Chaturvedi P, Kaushik J, Jain G, Parihar AKS. Computer and visual display terminals (VDT) vision syndrome (CVDTS). Med J Armed Forces India. 2016;72(3):270-276. https://doi.org/10.1016/j.mjafi.2016.03.016.

[25] Argilés M, Cardona G, Valentino M. Characterization of eye blink parameters during high and low-dynamic scenes in different video game genres. J Optom. 2026;19(1):100584. https://doi.org/10.1016/j.optom.2025.100584.

[26] Akkaya S, Atakan T, Acikalin B, Aksoy S, Ozkurt Y. Effects of long-term computer use on eye dryness. North Clin Istanb. 2018;5(4):319-322. https://doi.org/10.14744/nci.2017.54036.

[27] Bogdănici CM, Săndulache DE, Nechita CA. Eyesight quality and computer vision syndrome. Rom J Ophthalmol. 2017;61(2):112-116. https://doi.org/10.22336/rjo.2017.21.

[28] Lema AK, Anbesu EW. Computer vision syndrome and its determinants: a systematic review and meta-analysis. SAGE Open Med. 2022;10:20503121221142402. https://doi.org/10.1177/20503121221142402.

[29] Boadi-Kusi SB, Abu SL, Acheampong GO, Adueming PO-W, Abu EK. Association between poor ergophthalmologic practices and computer vision syndrome among university administrative staff in Ghana. J Environ Public Health. 2020;2020:7516357. https://doi.org/10.1155/2020/7516357.

[30] Singh S, McGuinness MB, Anderson AJ, Downie LE. Interventions for the management of computer vision syndrome: a systematic review and meta-analysis. Ophthalmology. 2022;129(10):1192-1215. https://doi.org/10.1016/j.ophtha.2022.05.009.

[31] Singh S, Keller PR, Busija L, McMillan P, Makrai E, Lawrenson JG, et al. Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults. Cochrane Database Syst Rev. 2023;(8):CD013244. https://doi.org/10.1002/14651858.CD013244.pub2.

[32] Więsyk PJ, Urbańska K, Wójcik P, Jasiński K, Wojdat A. Blue light and visual health: mechanisms, risks, and protective strategies. Quality in Sport. 2024;30:55218. https://doi.org/10.12775/QS.2024.30.55218.

[33] Żurowska E, Guderska U, Krawiel K, Król M, Kurzeja J, Markowska I, et al. Is blue light solely detrimental for human eyes? A concise overview of the current knowledge on how blue light affects eye health. Quality in Sport. 2024;21:52981. https://doi.org/10.12775/QS.2024.21.52981.

[34] Talens-Estarelles C, Cerviño A, García-Lázaro S, Fogelton A, Sheppard A, Wolffsohn JS. The effects of breaks on digital eye strain, dry eye and binocular vision: testing the 20-20-20 rule. Cont Lens Anterior Eye. 2023;46(2):101744. https://doi.org/10.1016/j.clae.2022.101744.

[35] Datta S, Sehgal S, Bhattacharya B, Satgunam PN. The 20/20/20 rule: practicing pattern and associations with asthenopic symptoms. Indian J Ophthalmol. 2023;71(5):2071-2075. https://doi.org/10.4103/ijo.IJO_2056_22.

[36] Hwang Y, Shin D, Eun J, Suh B, Lee J. Design guidelines of a computer-based intervention for computer vision syndrome: focus group study and real-world deployment. J Med Internet Res. 2021;23(3):e22099. https://doi.org/10.2196/22099.

[37] Trancoso Vaz F, Fernández-López E, Roig-Revert MJ, Martín A, Peris-Martínez C. Improving visual comfort during computer gaming with preservative-free hyaluronic acid artificial tears added to ergophthalmological measures. Vision (Basel). 2023;7(1):5. https://doi.org/10.3390/vision7010005.

Digital Eye Strain in Esports Athletes: Blink Suppression, Ocular-Surface Symptoms, and Binocular Vision Findings - A Narrative Review

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