What happens at night that causes dryness?

[MikeM]

I find that my dry eye symptoms are largely influenced by night time dryness. If I awake to good vision it tends to remain good throughout the day. Likewise it I wake to poor vision and dry symptoms they persist for the entire day. The better (longer) nights sleep I get tends to equate to worse dry eye symptoms.

I've tried numerous gels at night and just when I think I have discovered one that works consistently I have a string of bad days. I really can't wear an eye mask/shield at night as it causes me to awaken and sleep poorly. I have tried several types to no avail.

I guess I'm wondering what is physically occuring at night and how to remedy the problem? I don't believe I have eyes slightly open when I sleep. I'm convinced that if I can somehow infuse hydration at night I can relieve 75% of my issues. Oh, and I am using a humidifier in my bedroom.

[Hopeful2]

Mike,

Have you tried the Onyx/Quarts silicone goggles yet? I have been using mine for almost a week and I can honestly say that I barely notice them. Here is what I do to make them more comfortable. I loosen the strap so that I can barely feel it on the back of my head. . . I hate the feel of tightness on the back of my head. Because the goggles could easily slide off with the lose strap, I use micorpore tape to hold the goggles in place. I just use two strips of tape and make an X over each goggle. The tape also has the goggles closer to my eye and eliminates the little gaps. I find the goggles get some condensation in them over night. Because the goggles are sooo soft, I am easily able to sleep on my side and even partially on my belly. My next step is to order some of the white foam pads that come with tranquileyes to insert into the goggles. This will keep my eyes closed.

I didn't think that I slept with my eyes open, but I woke up a few times with the sensation of having rubbed my eyes into my pillow. I ended up with an abrasion once, so I think I do have a tendency to sleep with my eyes partially open.

I have stopped using ointments as I find that they tend to irritate my lids along the lash line.

Best of luck on the night goop, shield hunt!

[georgiav]

Mike M,

I am in the same boat as you and wonder what I can do (I have tried all the things you have). I believe the fact that we do not blink at night has a lot to do with it. I have heard some people using Saran Wrap (you will see their posts), but I cannot imagine what this would be like.

[Alan27]

I have posterior blepharitis with MGD and never experienced this night dry eyes, shouldn't your eyes remained humidified and hydrated because your eyes are closed and the tears can't evaporate?

[magoo]

Perhaps tear production slows down like a lot of other functions of the body while sleeping?
Also, we are not blinking at all and not moving eyes much to spread whatever tears are produced.

My eyes are dry and eyelids are stuck to them in the mornings. If I use gels or ointments they irritate my eyes so I put some drops in and let them work their way up under the lids first thing in the morning.

[spmcc]

My ophthalmologist told me this:

* MGD is worst in the morning and improves with blinking. Dryness in the morning is not due to decreased tear production at night (my cornea specialist says this does not occur - basal tears are always being produced). The dryness is because blinking, which draws oil out of our MGs, does not occur at night. Therefore, people with MGD wake with pain and improve during the day (in general - this can be compromised if you have any lid abnormalities that impinge on blinking function).

(You could also be sleeping with your lids slightly open and therefore drying out your ocular surface at night.)

* Aqueous deficiency is worst in the afternoon and also improves with blinking. Punctal occlusion can help with aqueous deficiency.

There is a little chart of this in Scheffer Tseng's article A Practical Treatment Algorithm for Managing Ocular Surface and Tear Disorders, Cornea, Oct 2011 (see pubmed: http://www.ncbi.nlm.nih.gov/pubmed?t...ular%20surface)

PM me with your email address if you want the full-text pdf.

[magoo]

I had forgotten about blinking drawing the oil out. Oh my, this is all so complicated. Thank you, spmcc, for the information about the tears at night, also.

[spmcc]

I had forgotten about blinking drawing the oil out. Oh my, this is all so complicated. Thank you, spmcc, for the information about the tears at night, also.

Yes, you'd assume that if tear production declined at night, then those people with aqueous deficiency would wake up in pain (like us guys with MGD). Instead, they wake up feeling great, but get worse as the day progresses.

As for blinking, there are blinking exercises to increase oil (see blinking exercises).

The instructions for blinking exercises were given to me by Dr. Patel at the Herzig Eye Institute in Toronto.

[Hopeful2]

I understand that blinking draws out the oil. . . So why do 'normal' people not wake up with dry eyes? They have not been blinking through the night either, so shouldn't they be experiencing some dry eye in the morning?

Could it not be that the mucin layer just doesn't keep the tears on our eyes through the night, for those use with dry eye?

[MikeM]

Thanks all, I will give these ideas a try.

[MikeM]

I am pretty much convinced at this point that my dry eye issues are mostly nightime induced, at least with my left eye. How I see in the AM is how I see for the day. I think what happens is I suffer from minor abrasion produced during the night and it takes a day to heal. If the abrasion occurs I have a bad day of vision, if the eye is hydrated and lubricated well, I have good vision the next day.

I'm going to talk to my Dr about other options/gels for night use.