What You Need to Know About Dry Eyes at Night

Dry eyes at night can cause discomfort and affect your vision, leading to a miserable experience. Many people are unaware that effective treatments are available to alleviate these symptoms. We’ll explore the causes, symptoms, and treatment options for dry eyes at night, providing the information you need to seek relief.

Causes of Dry Eyes at Night 

Dry eyes occur when there is an imbalance between tear production and removal. Several factors can contribute to this imbalance, including:

  • Age: Our eyes naturally produce fewer tears as we age, increasing the likelihood of dry eyes at night. According to the Canadian Association of Optometrists, approximately 30% of adults aged 50 and above experience dry eyes.
  • Contact lenses: Wearing contact lenses for extended periods can reduce tear production and contribute to dry eyes at night. Studies show contact lens wearers are more prone to experiencing dry eye symptoms.
  • Dehydration: Insufficient fluid intake can lead to reduced tear production and poor tear quality. Staying hydrated is essential for maintaining proper tear film and preventing dry eyes.
  • Environmental factors: Wind, smoke, pollution, and allergens in the air can increase the development of dry eyes, especially at night when ecological exposure may be higher.
  • Eye surgeries: Refractive eye surgeries, such as LASIK or PRK, can temporarily disrupt tear production, leading to dry eyes. However, these symptoms often resolve within a few months post-surgery.
  • Hormonal factors: Hormonal changes due to pregnancy, menopause, or the use of birth control pills can affect tear production, making women more susceptible to dry eyes at night.
  • Medical conditions: Chronic medical conditions like Sjogren’s disease, rheumatoid arthritis, and diabetes can contribute to dry eyes, including the nighttime variety.
  • Medications: Certain medications, such as antidepressants, antihistamines, and decongestants, can reduce tear production as a side effect, leading to dry eyes at night.
  • Nutritional deficiencies: Inadequate intake of essential nutrients like Vitamin A and omega-3 fatty acids can affect tear production and eye health, increasing the risk of dry eyes.
  • Sleeping with the eyes open (nocturnal lagophthalmos): This condition, where individuals sleep partially or fully open, can cause increased tear evaporation and lead to dry eyes at night.

Symptoms of Dry Eyes at Night

Dry eyes at night can manifest with a range of symptoms, which may include:

  • General dry eye symptoms, such as burning, itching, or a gritty feeling
  • Difficulty keeping eyes closed during sleep
  • Red or irritated eyes upon waking
  • Blurred vision and light sensitivity in the morning
  • Discomfort wearing contact lenses

Diagnosis and Assessment

An eye care professional can diagnose dry eye syndrome and help identify potential nighttime-specific factors. Several diagnostic tests and assessments may be performed to determine the exact cause of dry eye symptoms:

1. Tear production assessment: This evaluation measures the quantity and quality of tears produced by the eye. Standard methods used include:

  • Schirmer’s test: A small strip of paper is placed under the lower eyelid to measure tear production over a set period.
  • Phenol red thread test: A cotton thread with a pH-sensitive dye is placed under the lower eyelid, and tear production turns the dyed red, allowing for assessment.

2. Tear film stability evaluation: These tests assess the stability and composition of the tear film, which can affect tear evaporation and overall eye health:

  • Tear film breakup time (TBUT): A non-toxic dye is applied to the tear film, and the time it takes for dry spots to appear is measured. A shorter TBUT indicates an unstable tear film.
  • Tear osmolarity test: A small sample of tears is collected to measure the concentration of dissolved particles; higher osmolarity indicates increased tear film instability.


3. Ocular surface examination: This assessment evaluates the health of the ocular surface and identifies potential areas of damage or inflammation:

  • Slit-lamp exam: A high-intensity light and microscope examine the eyelids, cornea, conjunctiva, and associated structures for abnormalities.
  • Corneal and conjunctival staining: A dye, such as fluorescein or a lissamine green, highlights any damaged or inflamed areas on the cornea and conjunctiva.

4. Meibomian gland evaluation: Meibomian glands produce the oily layer of the tear film, and dysfunction can contribute to dry eye symptoms. Assessment methods include:

  • Meibography: A specialized imaging technique used to visualize the structure and function of meibomian glands.
  • Meibomian gland expression: The eye care professional gently applies pressure to the eyelids to assess the flow and quality of meibum, the oily substance produced by the glands.

5. Patient history and symptom assessment: A thorough review of the patient’s medical history, current medications, and daily habits can help identify potential factors contributing to nighttime dry eye symptoms.

Treatment Options for Dry Eyes at Night

Fortunately, several effective treatment options are available for managing dry eyes at night. Consultation with an optometrist is crucial to determine the most suitable approach for your condition.

  • Artificial tears: Over-the-counter (OTC) artificial tear drops can temporarily relieve the missing moisture in your eyes. Look for preservative-free options, as they minimize the risk of irritation.
  • Punctal plugs: These tiny plugs are inserted into the tear ducts to block drainage, allowing natural tears to stay on the eye surface longer and reduce dryness.
  • Prescription tear-enhancing drops: For more severe cases, your optometrist may prescribe medication like cyclosporine eye drops to increase tear production and improve eye lubrication.
  • Medication adjustment: If your dry eyes are caused by a medication you are taking, your optometrist may work with your healthcare provider to explore alternative medicines without the side effect of reduced tear production.
  • Anti-inflammatory treatment: Inflammation in the eyes or eyelids can contribute to dry eyes at night. To address this issue, your optometrist may recommend anti-inflammatory eye drops, washes, or ointments.
  • Eyelid surgery: In some instances, when nocturnal lagophthalmos is the cause of dry eyes at night, surgical intervention to strengthen weakened eyelid muscles may be necessary.

What You Can Do at Home for Your Dry Eyes

In addition to professional treatment, there are simple steps you can take at home to manage dry eyes at night:

  • Stay hydrated by drinking plenty of water throughout the day.
  • Ensure you get enough restful sleep, as sleep deprivation can worsen dry eye symptoms.
  • Use over-the-counter (OTC) artificial tears as needed, especially before bed.
  • Avoid environments with triggers like smoke or pollution that can exacerbate dry eyes.
  • Limit your screen time and take regular breaks to rest your eyes and reduce eye strain.
  • Wear glasses instead of contact lenses, which help retain moisture and reduce dryness.
  • Ensure your diet includes foods rich in Vitamin A and omega-3 fatty acids, such as leafy greens, fish, and nuts, to support eye health.

The Importance of Seeing an Optometrist

While self-care measures can provide temporary relief, consulting an optometrist for a comprehensive eye examination and tailored treatment plan is essential.

An optometrist can accurately diagnose the underlying cause of your dry eyes at night and provide personalized guidance. They will monitor your condition, manage any underlying medical conditions, and help prevent potential complications. Regular eye examinations can also lead to early detection of other eye conditions contributing to dry eyes.

If you’re experiencing dry eyes at night and need professional guidance, consider making an appointment with Garibaldi Eye Care in Squamish, Canada. Their team of experienced optometrists is dedicated to providing expert care and customized solutions to improve your eye health.