Do Your Eyes Feel More Dry in the Mornings?

Feb 02, 2021

It is said that dry eye has as many symptoms as it has causes. One person's dry eyes may feel completely different than the next person's dry eyes. Some patients complain that they are dry and scratchy and the next complains that they are irritated and watery.

Some of my patients feel their dry eyes feel worst and night and some feel worse in the mornings. When you have eye irritation first thing in the morning, there are usually a few key reasons.

One of the first questions I like to ask my dry eye patients is, "Do your eyes feel more tired and irritated first thing in the morning or at the end of the day?" The reason that I like to ask this question is that I want to get to the root cause of the dry eye symptoms.

Knowing when the eyes are most dry tells me a lot about the lids. The eyelids are playing a role in their dry eyes when patients tell me that their dry eye symptoms are worse first thing in the morning.

The answer to this one question can tell me one of two things.

Question

"Do your eyes feel dry, gritty, or scratchy as soon as you wake up in the mornings?"

There are 2 major causes for this symptom:

1) Eyelids are not closing all the way while sleeping (aka Nocturnal Lag Ophthalmos)

2) Overgrowth of bacteria on the eyelids and lashes (aka Blepharitis)

No. 1) Eyelids Not Closing Completely

Test to see if your eyelids are closing completely

The easiest way to find this out is to ask a loved one if they have ever noticed your eyes being partially open when sleeping. One of my children has done this since she was an infant. So, someone in your life may have already noticed this to be true for you as well.

If no one has noticed, you can do a quick test.

Tilt your head back about 30 degrees
Close your eyes gently, like you're sleeping
Have a friend use a small light or pin light, even the light from your phone would work
Shine the light right in between your eyelids
Is there a little bit of white or a shiny reflection in between the lashes
If so, your eyes aren't completely closed.
Also, check to see if the lids pull open easily, by gently pulling on the upper lids.
If the lid pulls open easily this may be happening when you roll over while sleeping

What can you do about it?

If your eye is not closed all the way while you're sleeping, then your eye is drying out. This can start out as an annoying way to wake up each morning and turn into a very painful problem over time.

Use an Ointment

To alleviate this problem, I would start with using an artificial tear gel or ointment in both eyes before sleeping. Try an over-the-counter ointment like Refresh PM, Systane Nighttime, or Soothe Nighttime. To use these ointments take a little strip of the ointment on the tip of your clean finger. Then, look up towards the ceiling and roll the ointment into your eye. Make sure that you are already in bed when you do this though. Your vision will be significantly blurred by the ointment. And, you won't be able to watch the news or read a book after using the ointment.

Use an Artificial Tear Gel

If you don't like the blurry vision or residue that these thick ointments leave on your lids in the morning, try a gel drop instead. The gel drops are not quite as thick and are dispensed in a regular dropper bottle. So, they are a bit easier to use. Simply drop the gel in your eyes when you are ready for bed just like you would any other eye drop. A couple of brands to try are: Refresh Gel, Systane Gel, or GenTeal Tears Gel.

For a full list of artificial tears gels and ointments, download the Ultimate Guide to Artificial Tears here.

Use Sleep Goggles

SLEEP GOGGLES

If your eyes are still dry when you wake up in the morning despite using the gel drops or ointment, then try using a sleep goggle to provide a moisture seal around the eyes. I have found the best sleep goggles to be Eye Seals from Eye Eco. I like the Silicone goggles for petite faces and the Eye Seals 4.0 Moisture Chamber Goggles for those who sleep with a C-PAP machine. In fact, if you use a C-PAP machine and you have dry eyes, I highly recommend you use sleep goggles. They will protect your eyes from the air blowing into them from an ill-fitting mask.

EYE SEALS

Either of these goggles has given my patients amazing results. The strap that goes around the head is adjustable and comfortable. But, the best part is the moisture that is created inside the googles. The moisture air keeps the eyes comfortable all night long.

No. 2) Overgrowth of Bacteria

We all have bacteria that live on our lids and lashes. It is normal for some bacteria to be present there. However, the bacteria can over-populate and cause irritation to the front surface of the eye. And, when you are sleeping your eyelids stay in close contact with your eyes for hours at a time without blinking. If you have bacteria on your lids, your eyes will feel most irritated after prolonged contact with your lids. You may have an overgrowth of bacteria if you have:

Crusts or flakes in between your eyelashes
Redness at the inner rim of your lids
Eyelid margins that are thickened
Itching at the base of your lashes
Brittle or missing lashes
Frequent or recurring styes

What causes the bacteria to overpopulate?

Changes in hormones
Poor contact lens hygiene
Sleeping in contact lenses
Not completely removing eye makeup before bed
Poor lid hygiene
Lowered immune system

How Can You Get Rid of the Bacteria?

At home, you can use an over the counter lid and lash cleanser to minimize the bacterial population. For a full review of lid and lash cleansers, check out this blog. You will want to clean your lids and lashes twice a day when you first notice the irritation.

If you don't find relief from using at-home remedies, you will need to see your eye care professional for a prescription or in-office therapy. A doctor can prescribe antibiotic ointments, drops, or oral pills to get rid of the bacteria on your eyelids and lashes.

CONCLUSION

There are two main reasons why your eyes might feel worse in the morning from the dryness and irritation standpoint. It is important to pinpoint the problem to get to the root cause of your dryness symptoms.

If your eyes feel drier in the morning, it could be that your eyelids are not coming all the way closed while you're sleeping, or that you have an overgrowth of bacteria in those lids and lashes.

Using a lid and lash cleanser before going to bed each night will prevent overgrowth of the bacteria which normally live on our lids and lashes. And, using an artificial tear gel or ointment before you sleep each night can help to keep the front surface of your eyes moisturized all night long.