Many chronic dry eye patients face their worst challenges at night, when for a variety of reasons their eyes become more vulnerable to severe drying and corneal erosions.
I offer here some simple, practical strategies to reduce night dryness. Before employing any of these ideas or products, ALWAYS DISCUSS IT WITH YOUR DOCTOR!
My night dry eye recommendations revolve around effective environmental control and physical barriers over the eyes (typically in addition to, rather thanreplacing, 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 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/risks of 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.] I believe 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 many situations.
- PHYSICAL BARRIER PROTECTION (e.g. Tranquileyes, Onyix/Quartz, Eyeseals; sleep masks, patches and tapes; see dryeyeshop.com for full range of options). 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 I mean by physical protection? Simply covering your eyes so as to reduce evaporative tear loss, keep in moisture, and keep out moving air from fans, a/c and heating. 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; however, even people who know their eyelids seal usually get a benefit from a barrier. 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 like the ones in the dry eye shop. But there are also many products developed specifically for overnight dry eye protection by a company called Eye Eco, Inc - including Tranquielyes, a soft rubber mask with foam liners and wettable foam inserts that seals in moisture overnight; silicone shields that come in black or clear, called Onyix and Quartz respectively; and a larger thermal plastic shield called EyeSeals. Whatever you choose to use, try to keep your eyes covered at least part of the night. Don't forget to keep anything you wear overnight CLEAN.
- HEAT, A/C, CEILING FANS: 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: A humidifier in the bedroom is helpful 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. Humidifiers are probably most relevant for people who have exceptionally low humidity in their home due to where they live.
- HEAT TREATMENT: 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.