Dry eyes occur when tear production is insufficient or tears evaporate too quickly, leading to discomfort, mild pain, redness, and a burning sensation. Several factors can contribute to dry eyes upon waking.

Nocturnal lagophthalmos

Sleeping with eyes partially open is medically termed nocturnal lagophthalmos. This condition involves the eyelids not fully closing during sleep, often due to weakness of the 7th cranial nerve, also known as the facial nerve. Potential causes of lagophthalmos include head or jaw trauma, damage to arteries supplying the facial nerve, Bell's palsy (a sudden, temporary facial muscle weakness), and poor sleep quality.

Poor tear quality

Both blinking while awake and closing eyes during sleep are vital for eye health. Blinking distributes tears across the eye surface, while closed eyelids during sleep form a thin tear film over the eyeball, essential for maintaining moisture and normal eye cell function.

Tears comprise three layers: the aqueous layer for moisturizing, the oil layer to prevent evaporation, and the mucin layer to help tears spread evenly across the eye surface. A deficiency or imbalance in any of these layers compromises tear quality, leading to dry eyes upon waking.

Dry keratoconjunctivitis is a common cause of reduced tear quality, specifically due to a deficiency in the aqueous component of tears.

Reduced tear production

Glands around the eyelids produce tears. Reduced tear production can stem from age, commonly affecting individuals over 65, or medical conditions such as blepharitis, thyroid disease, diabetes, rheumatoid arthritis, and Sjögren's syndrome. Certain medications, including decongestants, antihistamines, antidepressants, and blood pressure drugs, may also cause this side effect, leading to dry eyes in the morning.

Allergies

Allergies can cause dry, itchy, and burning eyes. If these symptoms primarily occur in the morning, allergens in the sleep environment, such as dust mites, mold, pet dander, or pre-sleep skincare products, may be the cause. Persistent allergies can damage the ocular surface, leading to or exacerbating dry eye conditions.

Contact lenses

Wearing contact lenses, especially overnight, can lead to dry eyes. The American Academy of Ophthalmology advises against sleeping with contact lenses unless specifically directed by an ophthalmologist.

Remedies for morning dry eyes

Doctors may recommend various treatments, including over-the-counter artificial tears, eye ointments or gels applied at night, punctal plugs (to block tear drainage ducts), intense pulsed light therapy for blocked oil glands, tear-stimulating medications, and antibiotics to reduce inflammation in oil glands.

Bao Bao (Source: Healthline)