Digital Eye Strain and Perceived Academic Burden Among Syrian Medical Students: A Multicenter Cross-Sectional Study of Symptom Burden and Associated Factors.

BACKGROUND: Digital eye strain (DES) is increasingly relevant in medical education because of prolonged screen exposure. Evidence from Syria remains limited, particularly regarding its relationship with perceived academic burden. We assessed DES symptom burden, preventive awareness, screen-use and ergonomic correlates, and perceived academic burden among Syrian medical students. METHODS: This multicenter cross-sectional study included 896 medical students from seven Syrian universities. A structured questionnaire combined investigator-developed items assessing ocular history, screen use, workstation ergonomics, preventive awareness, neck/shoulder pain, and perceived academic burden with the Computer Vision Syndrome Scale-17 (CVSS17). Correlation, ANOVA, and multivariable linear regression were used. RESULTS: Mean age was 20.84±2.17 years and 53.8% were female. Overall, 63.8% reported ≥6 hours/day of screen use, 51.2% reported uninterrupted use for ≥40 minutes, and 27.3% were classified in CVSS17 Levels 4-5. Only 10.4% regularly followed the 20-20-20 rule. In multivariable analysis (R2=0.219), higher CVSS17 scores were associated with female sex, corrective-lens use, physician-diagnosed dry eye, tablet use, and screen time ≥6 hours/day. Greater viewing distance, screen top at or above eye level, and reclined posture were associated with lower scores. CVSS17 scores were strongly correlated with perceived academic burden (r=0.762, p<0.001); CVSS17 score and neck/shoulder pain were independently associated with greater burden (R2=0.600). CONCLUSION: DES symptom burden was substantial and strongly associated with perceived academic burden. Screen exposure and workstation characteristics represent potentially modifiable correlates, although causality cannot be inferred. Prospective studies should evaluate whether screen-hygiene and ergonomic strategies reduce symptoms and support students' learning experience.