Waking Up With Dry Eyes
Medically Reviewed By Saya Nagori, MD. Dr. Nagori is an Ophthalmologist & Fellowship Trained Glaucoma Specialist
Are you waking up with dry eye? Dry eye syndrome can often get worse overnight and you may experience red eyes in the morning. Chronic dry eyes can cause watery eyes, itchy eyes, watery tears, blurry vision, and even light sensitivity. There are many different reasons that a person’s dry eye symptoms may become worse at night.
Environmental Conditions And Dry Eye
For the vast majority of people, dry eye that is worse in the morning is related to various factors in their environment. Some patients may have the air conditioning on too high or their room may be too dry during to heating units that are over functioning. Also patients who live in a dry climate may experience dry and painful eyes more than those who live in humid climates.
First, you should try to change environmental factors that could be contributing to your dry eye. For example, if you are sleeping under an air vent or a ceiling fan, this is likely to cause quicker tear evaporation. If you are able to use a humidifier to help with dry air in your sleep space, this can also help.
Next, you should try to change any habits that may be contributing to symptoms of dry eye. If you are in front of the computer screen for several hours, especially before bed, this is likely to result in more symptoms of dry eyes. This is because your blink rate naturally goes down when you are doing a focused visual task such as computer use or driving. The increasing use of digital screens is likely causing more and more dry irritated eyes in many people.
Eye Conditions Associated With Dry Eye
Blepharitis
Blepharitis (inflammation of the eyelids) is an eye disease that is strongly associated with dry eye. It is a chronic condition in which the fatty oils of the eyelid are stagnant and not functioning properly. Blepharitis is one of the most common causes of dry eye, and one of the common home remedies to treat it is through using warm compresses. Luckily, there are more advanced warm compresses now that can actually provide moist heat. Moist heat from an eye mask can help to open up the meibomian glands and improve the tear film that is on the surface of the eye. These tear glands play a large role in eye health, and meibomian gland dysfunction can cause many problems for the surface of your eye.
Refractive Errors
A refractive error means that you need glasses or contacts to see clearly. If you have a refractive error and use contact lenses, this is also a common reason for dry eye. If you sleep in your contact lenses at night, this is a very high risk for having dry eye that is worse in the morning. It is also very dangerous to sleep in contacts at any point in time because it increases your risk of vision threatening infections. Using daily contact lenses that you can throw out each evening can be a great option for patients who are waking up with dry eye.
If you have had vision correcting surgery like LASIK or PRK, you may also experience more dry eye than others. If you already have significant issues with dry eyes, you may want to choose PRK over LASIK as this is associated with less dry eye.
Glaucoma
Patients with glaucoma who need to take multiple eye drops or medications may also experience significant dry eye. This dry eye may be worse in the morning because may glaucoma drops are commonly taken at night.
Sleeping With Eyes Open
If you live with a roommate or a partner, ask them to check on you while you are sleeping. It is possible that your eyes may not be fully closed while you are asleep. This leads to prolonged exposure of the surface of your eye and your cornea to the environment. This can lead to significant drying of your eyes. If this is the case, you can try using a sleep mask while you sleep so that your eyes are more likely to remain shut. You will need to give this intervention a few days to a couple weeks to work as the damage from exposure can be significant and can take time to heal.
Floppy Eyelid Syndrome
Floppy eyelid syndrome and sleep apnea can be associated with the feeling of dry eye. In floppy eyelid syndrome, patients eyelids are very lax and due to this laxity they can develop conjunctivitis and dry eye. Floppy eyelid syndrome is associated with sleep apnea, and sleep apnea is a potentially fatal condition. If you think you have this condition you should see your primary care doctor or a sleep specialist as soon as possible. They can order a sleep study to help determine if you are getting enough oxygen at night. In order to manage the ocular symptoms, you should use artificial tears and a gel lubricant to soothe the eyes. You may need to also use an eye shield, eye mask, or even tape the eye shut so that the eyelid does not evert during sleep. Addressing any underlying obesity and sleep apnea can also help to improve symptoms. Avoid sleeping on your face and belly as well as this could make things worse. In addition to seeing a primary care doctor and a sleep specialist, make an appointment with an ophthalmologist to have a complete eye exam.
Sleeping With Contacts
Sleeping with contact lenses in your eyes is likely to cause symptoms of extreme dry eye. It is not recommended to sleep with your contact lenses in for naps or at night. Leaving contact lenses in while you sleep is dangerous and can lead to sight-threatening infections. It also is likely to cause extreme dry eye. Your eye needs a chance to breathe and it is important to take contact lenses off when you are sleeping.
Severe Dry Eye
In general, if you have severe dry eye, this can mean that you will wake up with dry eye. Severe dry eye can also be related to medical conditions like Sjogren’s syndrome. Severe dry eye can also cause blurry vision. If you are feeling that your dry eye is severe, it is a good idea to get a full eye exam from an ophthalmologist.
Treating Dry Eye That Is Worse In The Morning
Treatment will depend on why you may be having dry eye.
Warm Compresses & Supplements
If you have severe blepharitis, you may need to use warm compresses, and be evaluated for more intense treatment like intense pulsed light therapy. In patients with Sjögren syndrome, nutritional supplements like oral omega-6 essential fatty acides can help as well.
Artificial Tears
In many cases of insufficient tear production, using artificial tears can help greatly. Dry eye is also increasingly common as we get older, and as we increase screen time. Since we can not reverse aging and some people’s jobs require a significant amount of screen time, the first step is to use preservative free artificial tears to help replenish your film of tears. There is very little downside to using artificial tears (unless the product has been recalled for some reason – see Ezricare eyedrop recall article on this website), and it can be a very effective treatment for blurred vision from insufficient tears.
Antibiotics
If you develop a corneal abrasion from dry eye you will need an antibiotic eye drop to treat the abrasion first. While not drinking enough water can affect dry eyes in cases of severe dehydration, this is likely not the cause of your dry eye.
Gel Tears
For patients whose dry eye is especially worse in the morning, use a thicker gel tear at night. Gel tears can provide hours of lubrication because they are very viscous in nature. The one thing to be aware of is that due to the fact that gel tears are very thick, they can actually make your vision blurry for ten or fifteen minutes after application. Therefore, it is a good idea to use the gel tear after you are already in bed, and about to close your eyes for sleep.
Punctal Plugs
If using artificial tears does not help much, you can ask your ophthalmologist about punctal plugs. These plugs are placed inside the tear ducts of your eyelids and are generally very safe and help your tears stay on the surface of the eye longer.
Prescription Drugs
Prescription drugs that help you if you are not making enough tears. These drugs work by increasing the production of your body’s natural tears. Generally, patients need to use these prescriptions for at least 2 to 3 months consistently before they notice a difference.
There is also a nasal spray available that can help with producing more tears. In order to get a prescription for one of these medications you will need to make an appointment to see an ophthalmologist. Generally, the eye doctor will not prescribe these unless you have already tried using preservative free artificial tears first.
Related: Eye Mask For Dry Eyes
Waking Up With Dry Eyes: Summary
Getting dry eye under control can take a long time. It is a common condition and many patients will feel that their dry eye is worse int eh morning. If you dry eye is getting in the way of a good night’s sleep, try using artificial tears during the day and a gel tear at night. Eye care for dry eye is chronic and you will need to commit to treating it on a daily basis in order to see results. If your dry eye is due to meibomian gland dysfunction, intense pulsed light therapy may be an option for you. Remember that medical conditions can also contribute to dry eye as well as environmental conditions. Contact lens users and patients who have had laser vision correction are also at increased risk for dry eye. Switching to daily contact lenses can be helpful as well. Remember to have a comprehensive eye exam with your ophthalmologist to have the surface of your eyes evaluated appropriately. This is the best way to understand what is the cause of your morning dry eye.
Sources:
Salinas R, Puig M, Fry CL, Johnson DA, Kheirkhah A. Floppy eyelid syndrome: A comprehensive review. Ocul Surf. 2020;18(1):31-39. https://pubmed.ncbi.nlm.nih.gov/31593763/
Guillon M, Shah S. Rationale for 24-hour management of dry eye disease: A review.Cont Lens Anterior Eye. 2019;42(2):147-154. doi:10.1016/j.clae.2018.11.008 https://pubmed.ncbi.nlm.nih.gov/30497903/
Cope JR, Konne NM, Jacobs DS, et al. Corneal Infections Associated with Sleeping in Contact Lenses – Six Cases, United States, 2016-2018.MMWR Morb Mortal Wkly Rep. 2018;67(32):877-881. Published 2018 Aug 17. https://pubmed.ncbi.nlm.nih.gov/30114003/
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