Eye strain: a spotlight on the #1 ailment in gaming

Esports injury - eye strain

Key points

  • Eye strain is fatigue and pain from overworking your eye muscles
  • Learn intraocular and extraocular muscles
  • Short focal distance and limited area of gaze are the leading cause
  • Common symptoms including dry eyes
  • Learn how to prevent or recover from eye strain!


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The information contained on this website does not establish, nor does it imply, doctor-patient relationship. Esports Healthcare does not offer this information for diagnostic purposes. A diagnosis must not be assumed based on the information provided.

What is eye strain?

Eye strain is a condition that occurs after long hours of strenuous activity for the muscles in and around your eyes. For gamers, this will occur after prolonged screen time which includes short, rapid movements of the eyes and focus only on the monitor(s) in front of you.

Eye strain is exactly what it sounds like. After staring at your screen for hours on end, the muscles in and around your eyes become irritated or strained. There are muscles on the outside of your eyes for eye movement, and there are muscles inside your eyes to contract or relax the lens and pupil. Each of these muscles have the potential to become strained.

A quick video detailing the potential harms of video games from our Question of the Day series

Pertinent anatomy

It’s important to know some basic eye anatomy to understand eye strain. As previously mentioned, there are 2 groups of muscles for your eyes.

The first group of muscles are located outside your eyeball and move your eyes in their sockets. These are called extraocular muscles.

The second group of muscles are located inside your eyeball and contract or relax the lens and pupil. These are called intraocular muscles.

Extraocular muscles

There are 6 extraocular muscles that create all the movements of the eyes within the eye sockets. Four of these muscles are for basic, linear movement of the eyeballs:

  • Superior rectus: elevation of your eyes; looking upward
  • Inferior rectus: depression of your eyes; looking downward
  • Medial rectus: adduction of your eyes; looking inward
  • Lateral rectus: abduction of your eyes; looking outward

There are two additional muscles that create eye movement within the eye socket: superior oblique and inferior oblique. Both muscles perform an action called torsion, or the action of rotating your eyes within your eye sockets to keep them flush with the ground. This action allows you to rotate your head slightly, in either direction, without changing your perspective.

The superior oblique also creates depression and abduction, or the motion of looking downward and outward. The inferior oblique does elevation and abduction, or the motion of looking upward and outward.

extraocular muscles of the eyes
The extraocular muscles of the eyes

Levator palpebrae superioris

Two other muscles involved in eye strain are those that open and close your eye lids. The muscle that opens your eye lids is called the levator palpebrae superioris. During long hours of gaming, your blinking rate is reduced, which means the levator palpebrae superioris muscles are active for longer durations of time—thus leading to strain.

Keeping your eyes open for long periods of time may reduce the activation of the orbicularis oculi if you keep your eyes fully open. The basic function of this muscle is to close your eyelids.

However, another action of this muscle action can be described as narrowing the palpebral aperture, which is a fancy phrase for the action of squinting. This action can become more common if the screen brightness is too high, if you are experiencing the condition known as dry eyes, or if your vision is not properly corrected (e.g., glasses or contact lens prescription).

If you recognize that you are squinting during gaming sessions, we suggest you visit an eye doctor to address possible causes including the need for vision correction.

Intraocular muscles

There are 3 intraocular muscles that contract or relax the lens or the pupil. These muscles can be separated into 2 groups:

Ciliary muscles

The ciliary muscles are involved in the contraction and relaxation of the lens to allow focus on near or far objects.

  • Near focus: ciliary muscles contract and the lens becomes round
  • Far focus: ciliary muscles relax and the lens becomes flatter

This distinction is incredibly important considering most people’s gaming monitors are within 30 inches from their face. Therefore, the ciliary muscles will be active for the entire duration of the gaming session, thus leading to more rapid eye strain.

Iris muscles

The radial muscles of the iris will cause dilation or widening of the pupil, and the circular (sphincter) muscles of the iris will cause constriction of the pupil.

These muscles will work to change the amount of light that enters the eye. When there is insufficient or dim lighting, the pupils will dilate; when there is bright light, the pupils will constrict.

Ciliary muscles near and far
Ciliary muscles contract to release tension on the lens during near focus


Eye strain in gamers occurs when the muscles of the eyes become overworked due to playing video games. This is a combination of the limited area space where you focus your gaze and the static depth of focus.

Limited area of gaze

While gaming, most people use a monitor that’s in the range of 20-24 inches. During game play, your eyes will almost always stay within the frame of the monitor.

Exceptions include streaming or other activities where you have a dual monitor and your attention goes off screen, but the majority of your gaze will be within your gaming monitor.

In addition to the small area, many games will require your eyes to move rapidly around the screen. Whether searching for the enemy or tracking your character’s movements, your eyes will often move rapidly in this small space.

These rapid, small, repetitive movements can cause strain to the extraocular muscles.

Static focal distance

While gaming, your monitor will, hopefully, be approximately 24 inches from your face (check your setup!). During game play, your eyes will only ever focus to this distance—unless, of course, you move your body or monitor closer or further away.

Exceptions include streaming or other activities where you have a dual monitor and your attention goes off screen; however, your focal distance will still be relatively close.

Because your focal distance is static, or fixed, approximately 24 inches from your face, the ciliary muscles will hold a static contraction. Remember, the ciliary muscles are active to bend the lens for near focus.

The ciliary muscles will maintain this contraction for the duration of your game play, which will lead to eye strain during long gaming hours.

close up photo of eyes

Signs and symptoms

The most common symptoms of eye strain include irritation of the eyes:

  • Fatigue
  • Pain in eyeballs
  • Pain in the eye sockets
  • Blurred vision
  • Headaches
  • Occasional double vision

Another common symptom of eye strain is dry eyes, which is more than just lack of moisture on the surface of your eyeball. Symptoms may include:

  • Stinging or burning
  • Sensitivity to light
  • Redness of the sclera (the white part of your eyeballs)
  • Straining nighttime vision
  • Blurred vision

Common mechanism of injury

The mechanism of eye strain in gamers is partially explained in Pathophysiology above.

  • Limited area of gaze
  • Static focal distance

Moving your eyes quickly and rapidly in a small space combined with a short, static focal distance leads to eye strain, but there is also one more concern with gaming: blinking!


Blinking provides hydration to the eyes using moisture from tears and mucous secretions. In a normal, resting state, the average number of blinks per minute is around 20.

However, while gaming, this number may be less than half. During the hypervigilance of intense gameplay, you may only blink 5-10 times per minute, leaving your eyes at risk for becoming excessively dry.

Eye strain in gamers
Screen time without breaks can lead to eye strain!

Blue light concerns

Another common concern is how blue lights from LED screens and monitors may affect your eyes. To learn more about these effects, read our post on blue light which explains everything you need to know about blue light including how you can protect yourself.

Prevention and rehabilitation

Prevention of dry eyes and eye strain is pretty straight forward. In short, take breaks!

  • Every 5-10 minutes, blink! Blink your eyes and hold them shut for 3 seconds, 5 times total. This will allow the moisturizing mucus of your eyelids to cover and protect the outer surface of your eyes.
  • Every 20-30 minutes, take a 5-minute break to look away from your screen. Since the ciliary muscles relax during far focus, you’ll want to look at something far away. If you’re able to, look outside; if not, look as far as you can within your home.
  • Every 30-60 minutes, perform smooth pursuit OR target gaze (listed below) to help reduce the strain on the extraocular muscles.

Lastly, don’t forget the power of a good night’s sleep. If you’re constantly grinding to become the best, you will most certainly experience eye strain, and sleep is your best tool for recovery to continue gaming tomorrow.

Eye exercises

These three exercises are included in our Gamer Warm-up. We suggest performing the entire Gamer Warm-up prior to each gaming session.

Near-to-far focus

  1. Hold an object (for example, a pencil or your thumb) in front of your nose, approximately 12 inches away from your face
  2. Hold the object in front of a background target at least 20 feet away (for example, the wall of your room or any object outside your window)
  3. First, focus your eyes on the object (the pencil eraser or your thumb nail). Then, focus your eyes on the background target
  4. Repeat step 3 for a total of ten (10) repetition
Near-to-far focus

Smooth pursuit

  1. Hold an object (for example, a pencil or your thumb) in front of your nose, approximately 12 inches away from your face
  2. Without moving your head, slowly move the object back and forth, up and down, or diagonally
  3. Move the object in H-pattern and/or an X-pattern, moving it as far as your eyes can gaze without the need to move your head.
  4. Try to reach all four corners of your gaze

Target gaze

  1. Choose any focal point directly in front of your face; for example, a point on your computer screen
  2. Without moving your head, look directly upward as far as you can, as if you were looking at 12 on a clock. Then, return your gaze to the starting point in front of you
  3. Repeat this gaze pattern for each of the remaining 11 numbered positions on a clock in a clockwise pattern
  4. Repeat steps 2 and 3 in a counter-clockwise pattern, beginning again with 12 o’clock