Many chronic dry eye patients face their worst challenges at night, when their eyes may become more vulnerable to erosions.

We offer here some simple, practical strategies to reduce night dryness. Before employing any of these ideas or products, DON'T FORGET TO DISCUSS IT WITH YOUR DOCTOR!

Our night dry eye recommendations revolve around effective environmental control and physical barriers over the eyes (typically in addition to, not replacing, good lubrication).

Below are some basic suggestions for keeping night dryness under control, starting with the simplest. Of course, not all of these factors are applicable to all patients, but you may find that one or more of them is important in your case.

• EYE LUBRICATION (e.g. tears, gels, etc): This is a fundamental (and obvious) part of overnight protection: applying a lubricant - artificial tear, teargel, gel, or ointment. However, at night lubrication has its limits as well as its pitfalls. Conventional wisdom has it that viscous (thick) products such as gels or ointments should be used at night. Please understand we're not doctors and can't speak authoritatively. Nevertheless, we don't think this is right. We've had so very many reports over the years from patients getting progressively worse using a greasy ointment every night that we feel a lot of concern over long-term use of ointments for night protection. [Please note, if your doctor has prescribed ointment please DO NOT discontinue it without their permission and an agreed upon alternative strategy.] We humbly submit the idea that using artificial tears or non greasy gels plus stepping up other forms of protection (see below) may be a better and safer route. In addition, there are many patients for whom no lubricant however viscous will get them through a night anyway. So, read on:
• PHYSICAL PROTECTION (e.g. Tranquileyes, sleep masks, or taping): This is something relatively few people think of on their own but it can make an ENORMOUS difference in protecting vulernable, dry eyes against severe dryness, erosions and abrasions at night. What do we mean by physical protection? Simply covering your eyes effectively to reduce tear evaporation and keep in moisture. One reason this is so effective is that for many people, aggravated night symptoms may be related to an underdiagnosed condition called lagophthalmos, where the lids do not fully close. Eye protection can be as simple as a soft eye mask (like the type you can get for $2-3 at a drugstore to keep light out when you're napping), or a thicker more effective sleep mask. But the current gold standard product for eye protection at night is called tranquileyes (by Eye Eco, Inc.) - a soft rubber mask with foam liners and wettable foam inserts that seals in moisture overnight. Relatively new on the market, Tranquileyes is in our opinion an important investment for chronic dry eye patients. Tranquileyes also has new self-heating inserts called thermoeyes to provide a super high moisture environment. Whatever you choose to use, try to keep your eyes covered at least part of the night. Don't forget to keep it clean and dry: daily washing is in order.
  NOTE: For patients who for whatever reason cannot use tranquileyes (such as recent surgery, other special reasons for sterility concerns, or anatomical incompatibility), Medtronic has some disposable bubble bandages that are quite good for night protection, available in both sterile and non-sterile versions. Please see our Eyewear page - scroll to bottom - for links.
• HEAT, A/C, CEILING FANS (i.e. OFF): Heat and A/C dry out the air in the bedroom and aggravate overnight symptoms. The less you use of either at night, the better. Please also consider airflow. To the extent you've got air vents directly over you, you're going to suffer more than if not. Keep the ceiling fan off if possible as the increased airflow will contribute to more evaporation as well. During seasons, or in climates, where heavy use of heat or A/C is necessary, use of a humidifier and eye protection becomes even more important.
• HUMIDIFICATION (i.e. ON): A humidifier in the bedroom is indispensable for many chronic dry eye patients. Don't just go out and buy the first one you see, though. Check out consumer guides. It's also very important to keep your humidifier as clean as possible, otherwise it may contribute to the problem rather than help solve it.
• HEAT TREATMENT (i.e. DO IT): Just before bed is an excellent time to do your treatments for Meibomian gland dysfunction (failure of the oil glands in the eyelids to secrete enough oil to prevent rapid tear evaporation). Warm compresses, especially the rice baggy method, often result in excess oil secretions that blur vision for awhile, so bedtime can be a practical time for them, and some patients find that compresses just before bed help reduce their overnight symptoms.

I'm a minimalist. That's a euphemism for lazy. I try to do as little as I can get away with - while still doing enough for decent prevention. Occasionally i can get away with only Dwelle at night without consequences, and occasionally, I drop everything but Dwelle for a night just for the sheer pleasure of feeling somewhat closer to a normal human being!

But under normal circumstances, here's my bedtime routine:

• Fans off, and heat or A/C at a minimum. Hot or cold air blowing around is lethal to vulnerable corneas.
• Rice baggy : I'm a rice baggy believer. If there is anything I would like to hand down to posterity, this is it! I microwave it to a comfortable temperature (not too hot as there is always danger of burning, even when you're experienced - just warm enough that it will stay that way for awhile) and bring it to bed with me. I put it on for at least ten minutes - often leave it on till it cools - occasionally fall asleep and wake up in the middle of the night with it still on!
• Dwelle: One drop in each eye just after the rice baggy and before the goggle.
• Tranquileyes goggle: I get the pads wet while the rice baggy is in the microwave, then I kind of fold it up and hold it in one hand while I'm lying down with the rice baggy on. I wear it all night. If I'm too tired or forgot to wash out the pads that morning, I use a sleep mask instead.
• Dwelle on the nightstand just in case I wake up during the night and feel like i want more.
• Unisol, Dwelle or NutraTear first thing in the morning depending what my eyes feel like. My right eye is a real toughie. If I sense it's been a bad night I slop some Dwelle on it right away, otherwise I just use some Unisol to get things loosened up before putting in my sclerals.
• Ocusoft lidscrub foam in the shower takes care of any Dwelle residue (though actually the moisture in the Tranquileyes goggle usually absorbs it). Funny, I never used to use lidscrubs but in the last several months (I'm writing this in Oct 2007) I've really come to appreciate it. Economical too - one wee little 50mL bottle seems to last forever!

Surviving the office environment

Pain management

Travelling with dry eyes

Depression and anxiety

Eyewear

Bell's Palsy info site page on eye protection