So you’re waking up with dry eyes in the morning.

There are a few different ways this can happen. Sometimes you can wake up and it is actually quite hard to open your eyes is because they feel so stuck together. What is happening here is that there is so little moisture in your eyes that the back of the eyelids stick to the skin on the surface of your eyes. As you open your eyes you can actually tear off a tiny piece of skin off the front surface of your eye. This is called an epithelial erosion. There is no mystery if this happens because it hurts. It feels like someone is sticking a pin into your eye. These can heal up quite quickly, it just depends on how much skin has been torn off. A micro-erosion may be uncomfortable half an hour or so. If you tear off a big piece then this can take a few days to fully heal.

Another manifestation of morning dry eye is that you find it quite hard to see first thing in the morning. It’s a bit like the eyes take a while to “wake up”. It can take about 10 to 15 mins for the filmy vision to clear up. You might even feel as if there’s something wrong with your glasses because your vision is so blurred. I feel your pain being denied that all important cup of coffee in the morning. What’s happening is that the tear film is in poor shape and you need a smooth tear film in order to see properly. The quick fix is a drop of lubricant and your tear film is back in business again.

This is one of the puzzles of this type of dry eye and for some of you, it is the only symptom you get. No dryness in the day, it is just at night. The puzzle is that when your eyes are closed where are all the tears going? It’s possible that you might be secreting fewer tears at night. Another possibility though is that your eyes are not actually closed when you’re sleeping. This is a condition called lagophthalmos and it is along the little gap between the lids where major drying out can occur.

So what can you do about this? The main treatment is to put thick gels in your eye at night just before you go to bed. Even to re-apply the gel if you get up in the night. Examples of these types of gels are; Lacrilube, Genteal Gel, and VitA-Pos. You need to try different ones because people vary enormously in their preference for these types of gel. Some of you will find the thicker gels leave an uncomfortable residue in the morning but this can easily be cleansed off with warm water.

Another way of dealing with this is to keep some lubrication drops on your nightstand. As you wake up in the morning, before you even open your eyes, put lubrication drops on your closed eyelids. Then flutter your eyelid to let the lubrication in. Sorted. A nice bright start to the day.

Another strategy is to use a sleeping mask. You can use your airline sleeping mask that you got free of charge on your last flight. (You knew it would come in handy. What to do with the socks that came in the travel pack? I am thinking of throwing mine out.) If you want to get fancy then you can buy the king of sleeping masks called Tranquileyes. These provide a moist microclimate around your eyes. They do this with inserts that you moisten up before you go to sleep. This creates a beautiful humidity around your eyes all night. Of course, those of you sleeping under fans will want to think of some other ways to stay cool.

If you use as C-PAP machine for sleep apnea you might benefit from an eye shield at night. Sometimes the air can escape from around the C-PAP machine and blow across your eyes drying them out.

Finally, if all else fails you can tape your eyelids shut at night. There is a special tape that is not too irritating to your skin that you can use just before your bed.