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Ask the Eye Doctor: Why do my dry eyes hurt in the morning?

Posted on Wed, Sep 30, 2015

Q) Why do dry eyes feel awful in the morning when I first wake up, especially if I don’t use an eye lubricant at night?

Dr. Stephen Cohen

A) There are certain conditions that can get worse during the night with the eye in a closed state. For example, if you have blepharitis, which is caused by a common skin bacteria called “staph epidermidis,” the waste products of the staph are very irritating. But with your eye closed that staph toxin is lying there all night. If I have a patient who wakes up with really irritated eyes, one of the first things I want to look at is untreated blepharitis.

Another possible cause is called “recurrent corneal erosion.” Think about pulling a scab off all the time. It starts to heal and you pull the scab off. If the surface of the eye gets irritated through dryness and adherence to the back of the lid, or through an injury, that tissue needs to heal. The good news is it heals very quickly. The bad news is it hurts a lot as I’m sure you’ve found. So it heals quickly but it doesn’t necessarily anchor itself. That thin, outer layer of the cornea doesn’t anchor itself to the eye very fast, so you run the risk of re- irritating your eye even after you are feeling better. And when you do that over-and-over, it is called “recurrent corneal erosion.” You are basically tearing off the outer layer of the front of your eye. Classic sign is you wake up, you open your eyes and it hurts. Using ointments at night helps. Using an antibiotic ointment would help if you have blepharitis as well because it would treat that and give your eye a little more coating.

Dry Eye Tip!
If you have severe dry eyes and trouble opening your eyes in the morning because your lid is sticking, try to keep your eyes closed when you wake up and use the heels of your hands to gently massage your lids. What this will do is break any of those adhesions that may be there and it stimulates a little tear production so that you can actually open up your eye safely. But if you wake up and open up your eyes right away, you run the risk of – ouch – pulling that adhesion off, again, like pulling a scab off of a wound.

-Stephen Cohen, OD from his talk on Dry Eye at the SSF National Patient Conference

Click Here to View Audio CDs from Past  SSF National Patient Conferences

Topics: Dry Eyes, Sjogren's, Joint Pain, Fatigue, Treatment, Blepharitis

What is blepharitis & how do you treat it?

Posted on Fri, Jul 13, 2012

Blepharitis is a term denoting inflammation of the eyelids. It includes styes and even allergic reactions of the lids. The most common use of the term, however, refers to a condition involving the oil glands of the lid margin (about 20-25 openings in each lid) that produce the outer layer of tears. This oily layer serves to retard evaporation of the tears, thus conserving them. When inflammation affects these oilproducing glands, there is increased aporative loss of tears. Studies have shown that up to two-thirds of patients with Sjögren’s dry eye have this form of blepharitis. This condition is called posterior blepharitis or meibomian gland dysfunction and is the most common form of dry eye disease.


The most common form of treatment is the use of moist heat to the lids, cleansing of the lid margins and the use of oral antibiotics such as tetracycline. This regimen can result in significant improvement of the symptoms of irritation and pain. In more severe cases the use of locally applied steroids can be helpful. Current research is studying the use of locally applied hormone preparations and newer antibiotics to reduce inflammation and normalize the oil secretion.

By Michael A. Lemp, MD


Topics: Dry Eyes, Sjogren's, Treatment, Blepharitis

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