Why am I ok at night

[kimby2007]

I'm confused. I have severly dry eyes. I wear sclerals, have plugs, and am still dry. However, my eyes are fine during sleep. No sticking, no need for artificial tears. Why is this? My doc just said it is because I have a different type of dry eye. I am grateful but very confused.

[Rebecca Petris]

There's nothing uncommon about this. I know lots of people who are dry during the day and fine at night. Night dryness is often associated with poor lid closure, epithelial dystrophy or other conditions in addition to poor tear production.

[kimby2007]

Thanks

Thanks! It is good to know that I am not fabricating my daytime dryness.

[Smithy K]

Hiya

Its a strange one isnt it !

My eyes are fine in the day with Viscotears (use about 3 times in the day), then at night my RIGHT eye sticks to my eyeball, but only at the top edge ??? But when I drink Alcohol my LEFT eye goes straight to red after a couple.???????

Puzzling isnt it ! ...

karen

[indrep]

kcoffiner,
Typically people with low aqueous production will experience your type of experience of worsening conditions throughout the day. People with low lipid or mucin production will have worse conditions in the morning.

[calli66]

Indrep, could your clarify this? When you say 'worse conditions in the morning,' do you mean very dry during the night? (low lipid and mucin). Am I understanding you correctly?

Would this observation, whether one's eyes are more dry during the day, or more dry at night, be a diagnostic tool for what causes one's dry eye? I know that I've never been tested for levels of lipid or mucin, only tear quantity and tear break up.

Thanks,

C

[indrep]

Patients with aqueous deficiency and no lid deformity have a water tight seal during sleep so the cornea has "heal time".

Patients with meibomitis have more discomfort or pain in the morning because there has been less tear production overnight and the inflamed lids have been against the corneal surface where inflammatory mediators act on the corneal surface. Once these patients wake and tear production increases their symptoms can decrease throughout the day.

Unfortunately after a period of time dry eye disease becomes a multifactorial issue. The first cause of dry eye than leads to secondary causes. In other words you could start the intial onset with low aqueous. Then inflammation sets in and reduces lipid production. Then epithelial cells begin to die. Then goblet cell density is reduced and mucin production is decreased.

Now what does the doctor treat? This is why the disease confounds many. The goal of treatment is to stop the inflammatory cycle. This requires patience on the doctors staff to explain, patience on the patients side to be compliant with the many strategies or treatment recommendations and the time for them to work.

[calli66]

Thanks!

..for explaining that..it helps me understand my situation.

C

[Lucy]

Indrep, your posts are always written so the lay person can understand them and not on a doctoral level. Also, they are very helpful. thanks Lucy

[Justpeachythx]

Thank you for that explanation. It certainly helps me understand why sometimes I feel the balance shifting between day/night dryness. It reminds me why it's so important to maintain my day time regiment even when I feel only mildly irritated.

[portrgirl]

This has really helped me. I've been trying to understand why my eyes are painfully dry at night and only uncomfortably dry during the day (when I work 8 hours on a computer). My doctor said I have low mucin production. Ah ha. I've always assumed I wasn't closing my eyes tight enough (which I think is part of it), but even when they would be, it wouldn't always help.

[bernmee]

Indrep,

I'm going to send my lasik surgeon to you for "Dry Eye 101" classes. When I was in with him last week he said that if I have morning pain then I am atypical as people who suffer with dry eye feel fine in the mornng and get worse as the day goes on, he's still mystified...

Thankfully I'm not due to the help of a "dry eye" Dr. I found 10 weeks, and the help of all you wonderful people on this site

[LasikLady]

plugs and oil deficiency

Before I had all 4 plugs in I was the person who felt okay in the morning and then by the evening had dryness. After lunch things would steadily go down hill for my eyes. That was with only 2 ducts plugged. Now with all 4 done I am somewhat the opposite. In the morning my eyes are generally the worse and them improve once my tears get going. Then I am drippy eyed the rest of the day. I was wondering why this has changed. Now I think perhaps having all the excess tears is depleting my mucus layer somehow. Like watering it down creating another problem. My comfort improves big time everytime I use the hot compress. Even though I water alot often times I still burn so this kind of makes sense to me that I've watered down that oil or mucus layer with the over tearing. Does this sound right???