VDT syndrome

Disease Description (Causes and Symptoms)

• Definition: A collection of eye, musculoskeletal, and fatigue-related symptoms that occur when working while looking at a screen (Visual Display Terminal) such as a computer or smartphone for long periods (VDT syndrome).
• Main causes: Inappropriate working posture, chair, and monitor position (workplace factors); working hours and insufficient breaks (work-related factors); lighting, screen reflections, and environmental factors; and personal factors (age, underlying diseases, work habits).
• Summary of pathophysiology: Prolonged fixed gaze, repetitive wrist and shoulder work, and abnormal neck and back posture cause dry eyes and eye fatigue (increased accommodative and refractive burden), while overuse of muscles, tendons, and ligaments and postural imbalance cause pain, numbness, and limited movement.
• Typical symptoms: Eye fatigue, redness, foreign-body sensation (gritty feeling), photosensitivity, headache, pain and stiffness in the neck, shoulders, and shoulder-blade area, rounded back and lower back, and numbness and pain in the hands and fingers (carpal tunnel syndrome may occur in severe cases).

Treatment Methods

• General principles: Relieve symptoms + remove causes (correct the work environment and posture) → prevent recurrence in the long term.
• Work environment and posture correction (primary treatment)
  • Monitor distance: Approximately 50 cm or more (far enough that it cannot be reached with an outstretched arm); the top of the screen should be at eye level or slightly below.
  • Keyboard and mouse: Keep the elbows and keyboard at the same level, and maintain the wrists in a neutral position.
  • Chair: Adjust to provide lumbar support and allow the feet to touch the floor; adjust the armrest height.
  • Lighting/reflections: Minimize screen reflections and maintain a balance between ambient lighting and screen brightness.
  • Work-break schedule: For example, take a 10-minute break after 50 minutes of work (blinking and stretching are recommended).
• Management of eye symptoms
  • Relieve dryness with artificial tears (artificial tear eye drops).
  • Blink and rest the eyes (the 20/20/20 rule is recommended: every 20 minutes, look at something 20 feet away (approximately 6 m) for 20 seconds).
  • Ophthalmologic examination (check for refractive errors and ocular-surface disease). Computer glasses may be prescribed if necessary.
• Musculoskeletal treatment
  • Regular stretching and exercises: Do not maintain the same posture for a long time. Stretching is recommended for 8–12 seconds, repeated 3–5 times (focused on the neck, shoulders, and wrists).
  • Physical therapy (heat therapy, massage, muscle-strengthening and postural-correction exercises), and occupational therapy (ergonomic training).
  • Medication: Control pain with short-term oral analgesic anti-inflammatory drugs (NSAIDs) or muscle relaxants (as prescribed by a doctor).
  • Assistive devices: Consider a wrist brace and an ergonomic keyboard/mouse.
  • Specialized treatment: If persistent numbness, sensory loss, or muscle weakness occurs, or if there is no response to conservative treatment, evaluation by orthopedics or neurology and surgical assessment (e.g., surgery for carpal tunnel syndrome) may be necessary.
• Complications and precautions
  • If left untreated for a long time, it may progress to chronic muscle pain, tendinitis or tenosynovitis, carpal tunnel syndrome, chronic ocular-surface disease, and other conditions.
  • Avoid vigorously rubbing the eyes or applying excessive pressure (risk of eye injury).
  • Follow the doctor's instructions when taking prescription medication (check for side effects and interactions with other medications).

Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)

• Useful materials to bring
  • A list of currently used medications and supplements (including dosage and administration times)
  • Records of when symptoms started, factors that worsen or improve them, daily working hours, and break patterns (symptom diary)
  • Photos of areas with symptoms (posture), and photos of the work desk and monitor setup (the entire workstation)
  • Previous ophthalmology and orthopedic examination results (if possible)
  • Notes on symptom severity (pain score, frequency of numbness, etc.)
• Examinations that may be available during an outpatient visit
  • Visual acuity and refraction tests, ocular-surface examinations (tear film, Schirmer test, etc.), neurological examination, and, if necessary, electromyography (EMG), ultrasound, etc.

Examples of General Questions to Ask the Doctor

• What is the cause of this condition, and what is my risk of recurrence?
• What work-break schedule and specific posture (monitor, chair, and keyboard positions) are recommended?
• What are the side effects or precautions for the medication I am currently using (or the artificial tears)?
• Do I need any additional tests or a referral to another specialty (ophthalmology, occupational therapy, or neurology)?
• How long is recovery expected to take, and what are the goals of treatment?

Examples of Condition-Specific Questions

• Are the monitor distance and height and the chair setup at my workstation (photo attached) appropriate? Specifically, how should they be adjusted?
• I have wrist numbness and sensory loss. What tests are needed to determine whether it is carpal tunnel syndrome, and how likely is it to improve with nonsurgical treatment?