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