Why do you feel dry eyes when you wake up in the morning? Attention! In this case, you need to see a doctor immediately (with the correct "hydration" method)

Expert of this article: Li Zongou, Master of Ophthalmology, First Affiliated Hospital of Dalian Medical University

This article was reviewed by Lu Jianmin, chief physician, deputy director of the Department of Ophthalmology, the First Affiliated Hospital of Dalian Medical University

The first difficult thing you encounter every morning when you wake up

Just open your eyes

Sometimes it's because you haven't woken up yet.

Sometimes I feel dry eyes.

Need to blink or close your eyes for a while

To feel more comfortable

After a night's rest, the eyes

When you open your eyes again in the morning, you should feel “full of energy”

However, this is not the case.

Dry eyes are a problem that bothers many people.

Especially those who often face the screen

Frequent dry eyes

Why is this?

Let's find out together

Why do my eyes feel dry?

Dry eyes refer to a problem with the thin layer of tears in front of our cornea, the "tear film". According to the 2020 Chinese Dry Eye Expert Consensus, dry eyes are ocular surface damage caused by abnormal tear quality, quantity or fluid dynamics, which leads to symptoms such as dryness and visual fatigue. It is currently the most common ocular surface disease.

The surface of the eye has a tear film, which is evenly covered on the surface of the eyeball every time we blink. It is composed of a lipid layer on the surface, a water layer in the middle, and a mucin layer at the bottom. Every time we blink, we bring a new layer of tears to the eyes and form a new tear film. So when the blinking frequency decreases, the tear film becomes thinner, exposing the cornea to the air. The cornea contains a wealth of sensory nerves, so the eyes will feel dry and uncomfortable.

Many people feel dry eyes when looking at mobile phones or computers. In fact, this is because their eyes are focused on the screen, the frequency of blinking decreases, and the tear film cannot be updated in time. This is also the eye manifestation of "video terminal syndrome".

In addition, feeling dry eyes does not necessarily mean dry eyes. If you usually feel dry eyes and discomfort, you can first use the dry eye questionnaire scale (see the table below) to preliminarily judge your dry eye condition. If it is more serious, you need to go to the hospital to further clarify your tear condition through tests such as tear meniscus width, tear film breakup time, and tear secretion test I.

Photo courtesy of the author

Why are dry eyes more obvious when I wake up in the morning?

After falling asleep, since you cannot blink, the cornea needs to rely on the microcirculation of tears in the eyelids to keep it moist. Most people can close their eyes completely after falling asleep, but some people have their eyes slightly open after falling asleep due to physiological eyelid incomplete closure, hyperthyroidism exophthalmos, facial nerve paralysis and other problems.

If the cornea is exposed to the air all night, tears will evaporate more easily and new tear film cannot be brought in by blinking. When you wake up in the morning, your eyes will feel discomfort and burning sensation, and the dry cornea may even cause exposure keratitis.

Meibomian gland dysfunction (MGD) can also cause dry eyes. Meibomian glands are located in the upper and lower eyelids of the eyes, and secrete oil through the openings at the eyelid margins to stabilize the lipid layer of the tear film. If the function of the meibomian glands is impaired, the secreted oil composition is abnormal or the meibomian glands are blocked, the lipid layer of the tear film is destroyed, and the second layer of the tear film, the aqueous layer, evaporates easily, resulting in dry eyes.

Meibomian gland dysfunction is very common in people with oily skin and the elderly. After getting up in the morning, they will feel obvious dry eyes and even vision loss. Mild meibomian gland dysfunction can be relieved by hot compresses, while severe cases require meibomian gland massage.

In addition, because the tear gland secretion function and tear film stability are poor right after waking up in the morning, and the parasympathetic nerves are excited, people are more sensitive to pain, so the dryness of the eyes will be more severe during this period of time.

What kind of dry eyes should you pay attention to?

Many people feel that their skin is drier, especially when the seasons change. People with this constitution are more likely to suffer from dry eyes. In addition to drinking more water to replenish the water in your body, it is also very important to replenish the humidity of the environment.

If you have dry lips and dry eyes at the same time, you need to go to the rheumatology and immunology department of the hospital in time to conduct serological autoantibody tests to see if it is due to abnormal exocrine gland function caused by Sjögren's syndrome. There are many other immune system diseases and endocrine system imbalances that can also cause dry eyes, such as various connective tissue and collagen vascular diseases, thyroid dysfunction, diabetes, etc.

How to "hydrate" your eyes in daily life?

When you need to stare at the screen for a long time, remind yourself to blink more often, which can significantly improve the symptoms of dry eyes. In addition, adjusting the angle between your eyes and the screen, looking down at the screen, and opening your eyes at a smaller angle can reduce the surface area of ​​the tear film exposed to the air, reduce the evaporation of tears, and also alleviate the symptoms of dry eyes.

For people with meibomian gland dysfunction, you can prepare a clean hot towel at 40-45℃ and apply it to both eyes for 10-15 minutes, 2-3 times a day, which can effectively relieve dry eyes. The increased temperature can improve blood circulation around the eyes and dredge the oil of the meibomian glands.

Steam eye masks are mainly composed of activated carbon, which mainly generates heat, similar to the effect of hot towel compresses, and are better at controlling temperature than hot towels. It is worth noting that the various drug ingredients added to steam eye masks, such as anthocyanins that are claimed to promote the regeneration of rhodopsin in retinal cells and lutein that can alleviate the increase in myopia, are almost incapable of being absorbed by the eyes.

Wet chamber lenses can provide a closed space to provide constant temperature moist heat compress in front of the eye for a period of time, reducing tear evaporation caused by ocular surface exposure and air flow. It is suitable for dry eyes that are not effectively treated with various conventional treatments, and is also suitable for patients after cataract surgery and excimer myopia surgery.

Many people who wear contact lenses for a long time also feel dry eyes. You can replace your contact lenses with shorter-cycle ones. The corneal epithelial cells need to rely on the tear film to provide oxygen. Contact lenses with shorter cycles can provide more oxygen to the ocular surface, and the symptoms of dry eyes will also be alleviated.

If the above methods cannot relieve the symptoms of dry eyes, you can use eye drops to relieve dry eyes, also known as "artificial tears", such as polyvinyl alcohol, sodium hyaluronate, etc.

It is not recommended to use some "Internet celebrity" eye drops that are advertised as relieving visual fatigue, reducing conjunctival congestion and inflammation, and nourishing the cornea. The "tetrahydrozoline hydrochloride" added to these eye drops is an adrenaline drug that has the effect of constricting blood vessels and can quickly reduce conjunctival congestion, but long-term use may induce keratitis or glaucoma.

Some eye drops may make you feel that you can see things clearly after using them. This is because they contain neostigmine methylsulfate, a cholinesterase inhibitor that can shrink the ciliary muscle and reduce the pupil. Long-term use can lead to ciliary muscle spasm, more prone to visual fatigue, and even dependence.

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