Tweet
Why are nights so bad for us?
Here are some reasons:
- Aqueous tear production decreases during sleep.
- Heating, a/c and ceiling fans cause dry eye to swirl around over our eyes, increasing evaporative loss.
- Inadequate lipids in our tear film (from blepharitis/MGD) can impair its ability to keep itself intact throughout the night.
- Sudden eyelid movements during sleep or on waking can trigger erosions, where cells are literally torn off the surface of the cornea by a dry eyelid or the surface undergoes damage spontaneously from excessive dryness.
- Eyelids may not form a perfect seal, so some small portion of the cornea remains exposed and vulnerable. In mild forms this is called nocturnal lagophthalmos and is common (and commonly undiagnosed). More severe cases may result from Bell's palsy or thyroid disease.
How can we protect our eyes at night and feel better?
1. A physical barrier
Covering your eyes can make an enormous difference in protecting them against the effects of severe dryness or erosions at night. For most people with severe night dry eye symptoms, this is a key component in success.
When you look for a way to do this, you're aiming to achieve one or more of the following, depending on your needs:
- Eliminating air movement over the eyes
- Increasing humidity in the area immediately around the eyes by forming some kind of seal around them and, if possible, introducing moisture
- Holding lids still
- Holding lids closed so that no part of the cornea is exposed
Of course, trying to do all that and still sleeping comfortably is a challenge but thankfully there are many ways to do it! Below is a list of the most readily available solutions.
CAUTION: Please make sure you consult your doctor before trying any of these methods - none is failsafe and not all are appropriate for every type of dry eye patient. Always discontinue immediately if you see any signs of worsening or new symptoms.
Tranquileyes. This is the 'gold standard', the all-in-one foam-lined goggle that forms a seal, helps hold the lids closed and introduces moisture with moisture pads.
Onyix/Quartz. Same shape as Tranquileyes but a slim, foamless silicone shield that is low maintenance, easy to use and available in clear. Compatible with CPAP masks.
Sleep masks. These are not moisture sealing but for many people provide a very comfortable, practical way to get some protection.
Medical tape. Long ago this was pretty much the only option. It's a real nuisance but it works well for a lot of people.
Plastic wrap. Cheap & easy, and it often works quite well.
Patches. Medtronic makes a bubble eye bandage (single-use, with an adhesive) that is very good. Also check the shop for things I may have from time to time.
Bandage contact lenses. Wearing soft contact lenses at night to protect your corneas. Talk to your eye doctor for more information about this option. It's most often used as a temporary aid to healing but they are also sometimes used as a preventive measure to protect the corneas during the night.
2. Goops.
This is the one thing on my list that virtually everyone reading this page is already doing: drops, gels, ointments, you name it. But don't ignore this point just because you think you're already using the strongest stuff available: if you're still struggling with nights, it might be time to look at alternative lubricants in conjunction with some of these other steps.
Conventional wisdom has it that viscous (thick) products should be used at night and ointments (products with petrolatum and mineral oil) are frequently recommended by doctors. Please bear in mind I'm not a doctor and can't speak authoritatively and you should not take any internet advice over the advice of your own doctor. Nevertheless I encourage you to investigate this issue further if you are regularly using ointment. Many experts question the frequent use of ointments and whether it's good for us. Have a look at this EyeWorld article for example. I've personally had so very many reports over the years from people getting progressively worse using a greasy ointment every night that I feel a lot of concern over the assumed benefits of long-term use of ointments for night protection. To me it seems very simple. If you spread grease on a surface, water won't get through. That means your natural tears - bearing in mind that the few you make are especially precious to your corneas! - cannot get to the ocular surface to do even a partial job of nourishing and protecting them for however long the ointment is there.
If you always use ointment, don't let this scare you into discontinuing it without talking to your doctor and finding a good alternative strategy. I'm just saying you may need to look into this angle. I believe that using a really good artificial tear or non greasy gel plus the right physical barrier (see #1 above) may be a better and safer route. Of course, as you may already know I'm a die-hard fan of Dr. Holly's drops so my top recommendations are going to be FreshKote and Dwelle. But if something else works well for you at night, more power to you!
3. Open with care.
This is intended mostly for the RCE patients who get those painful episodes during the night. You may have already learned all this through experience: How you open your eyelids is vital to preventing erosions. A goggle or mask to help hold the lids still is helpful for some people. But training yourself to keep the lids down is the most important. You can't just jerk your lids open when you wake. Keep something on your night stand - a bottle of saline, drops, a wet washcloth - something that you can apply over your CLOSED eyes for awhile to 'soften things up' before attempting to open your eyes.
4. Compress before bed?
I put a question mark after it because heat is not always good for everyone and it's easy to overdo. But for me, 5-10 minutes under a nice warm rice baggy really seems to make a difference to my nights, presumably by getting those lipids flowing better.
5. Turn off heat, a/c, and fans if possible.
Conspicuously absent from my list here is humidifiers. If you're already using one, great! Make sure you clean it regularly and check humidity levels so that you're not overdoing it. If you're not using a humidifier, I'm personally ambivalent about the benefit (speaking exclusively for sleep-time, not just generally). Bear in mind I'm talking here about people with severe night symptoms. You can humidify the heck out of your life and still have terrible dry eye symptoms until you apply your solutions more directly to the environment immediately around your eyes - hence my emphasis on the various goggles and gizmos to wear.