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Dry Eye in the Morning

Why do people wake up with dry eye in the morning, and what can be done to alleviate this issue?

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Understanding the Cause: Dry Eye in the Morning

Dry eye in the morning typically results from inadequate tear production or accelerated tear film evaporation. Why does this occur more frequently during the night?

The Root Cause: Nocturnal Lagophthalmos

The Root Cause: Nocturnal Lagophthalmos

Nocturnal lagophthalmos, the inability to fully close the eyelids during sleep, often leads to dry eye in the morning. It is associated with weakness in the seventh cranial nerve due to several potential causes:

  • Cerebellar artery injury
  • Trauma to the jaw or skull
  • Bell’s Palsy

Incomplete eyelid closure exposes the eyes to air, disrupting the tear film's continuity, leading to dry eyes upon waking up.

A 2020 study revealed nocturnal lagophthalmos not only instigates dry eye in the morning but also deteriorates sleep quality. It was found that overstimulation of Muller's muscle, responsible for keeping the eye open, can trigger this condition.

Who is More Likely to Have Nocturnal Lagophthalmos?

Who is More Likely to Have Nocturnal Lagophthalmos?

Several groups are more susceptible to experiencing nocturnal lagophthalmos, and thus, dry eye in the morning:

  • Young individuals: Due to various lifestyle and sleep habits, the younger population might face a higher incidence of dry eye in the morning.
  • Shift workers: Disrupted sleep schedules and irregular sleeping environments can increase the risk of experiencing dry eye in the morning.
  • People with facial nerve problems or facial trauma history: These individuals might experience nocturnal lagophthalmos more frequently, leading to dry eyes upon waking up.
  • Bell’s Palsy patients: As Bell's Palsy causes temporary facial muscle weakness, patients are more likely to suffer from nocturnal lagophthalmos, subsequently leading to dry eye in the morning.
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Combatting Nocturnal Lagophthalmos: Preventive Measures

Combatting Nocturnal Lagophthalmos: Preventive Measures

Addressing dry eye in the morning involves effective strategies such as:

  • Aromatherapy
  • Using warm eye masks
  • Taking a warm bath
  • Taping the eyelids closed during sleep.

Relaxing activities, like the warm bath, can increase your parasympathetic activity, which regulates the “rest and digest” function and decreases sympathetic activity prior to falling asleep. This may also reduce the stimulation of the Muller’s muscle.

Taping the eyelids closed physically keeps your eyes covered, which should help keep them better lubricated.

Artificial tears can also be a viable option to manage symptoms of dry eye in the morning.

Other Causes of Dry Eye in the Morning

While nocturnal lagophthalmos is a common cause, there are several other factors that can lead to dry eye in the morning:

  • Environment: Dry or windy climates can cause increased tear evaporation, leading to dry eyes. Similarly, indoor environments with air conditioning or heating systems can dry out the eyes.
  • Prolonged Screen Time: Spending long hours in front of a screen can reduce the frequency of blinking, causing tear evaporation and resulting in dry eyes.
  • Age: As we age, tear production naturally decreases. This can result in dry eye in the morning, especially in older adults.
  • Medication: Certain drugs such as antihistamines, antidepressants, and certain blood pressure medicines can reduce tear production.
  • Health Conditions: Some health conditions like Sjogren's syndrome, rheumatoid arthritis, and diabetes can cause dry eyes.
  • Contact Lenses: Long-term use of contact lenses can cause dryness and irritation, leading to dry eye in the morning.
  • Sleep Position: Sleeping with your face against the pillow can cause your tears to evaporate more quickly, leading to dry eyes in the morning.

Remember, managing these factors can help reduce the incidence of dry eye in the morning.

The Root Cause: Nocturnal Lagophthalmos
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Common Questions

Yes, typically older females going through menopause are more prone to having dry eyes than others. Also people taking certain medications such as anxiety medications, antidepressants, antihistamines, antipsychotics, anti-muscle spasm medications, Accutane, beta blockers, contraceptives, as well as certain diuretic medications, are more prone to have dry eyes. Also people who are contact lens wearers who don’t properly take care of their contacts or are wearing contacts with low oxygen permeability may be more prone to dry eyes. Additionally, people who tend to work on a digital screen for a prolonged period of time can increase their risk of dry eyes.
You may have dry eyes if your eyes are feeling gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or if you’re experiencing light sensitivity. Dry eyes can also cause blurred vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up after going in and out of focus due to an unstable ocular surface caused by dry eyes.
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Summary

If you experience dry eye upon waking up, it is likely caused by nocturnal lagophthalmos. In addition to the suggestions listed above, a doctor can provide you with additional guidance on what to do to treat and resolve this issue. If you’d like to schedule an appointment for a consultation you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit. Our team of eye care professionals is ready and equipped to provide you with the care you need.

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