Dry Eyes at Night: When Symptoms Depend on the Time of Day

Dry eyes at night could result from contact lens use, taking certain medications, having health conditions, screen use, sleep habits, the environment, and hormonal changes, among others. Dry eyes can feel like burning or itching or like something is stuck in your eye. No matter the cause, there are ways to manage dry eye symptoms.

Nighttime Dry Eye Causes

Medication Use

Certain medications, including allergy medications, antidepressants, and blood pressure medications, contribute to dry eye. You may experience dry eye as a side effect during the day, at night, or at both times.

Dust, Wind, or Smoke

Exposure to dust, smoke, or wind during the day can irritate your eyes and lead to dry eye symptoms at night. Your nighttime environment can also contribute to the symptoms. For example, a fan above or beside your bed or an air-conditioner could cause dry eyes.

Hormonal Changes

Hormonal changes due to pregnancy, menopause, certain health conditions like polycystic ovary syndrome (PCOS) or thyroid disease, or medications that affect your hormones can cause dry eyes. The mechanisms behind each differ.

Sleeping With Your Eyes Open

Some people sleep with their eyes open—a phenomenon called nocturnal lagophthalmos (NL). Even slightly opening your eyes while sleeping can lead to symptoms, causing you to wake up with dry eyes. NL can affect tear production and contribute to dry eyes at night.

Certain Medical Conditions

Diabetes, rheumatoid arthritis (RA), Parkinson's disease, Sjögren's disease, and thyroid disease are all associated with a greater incidence of dry eye. If you have one of these conditions, it's possible for dry eye symptoms to occur more often at night.

Previous Eye Surgery

Dry eye is one of the more common side effects of refractive surgeries such as LASIK (laser-assisted in situ keratomileusis). It can affect some people for up to a year or more after the procedure. Previous eye surgery, such as LASIK, can cause dry eye symptoms and contribute to nighttime dry eyes.

Screen Time

Looking at digital screens for hours a day can lead to dry, strained eyes. Researchers conducted a literature review on the relationship between screen use and dry eyes and concluded that the primary cause of dry eyes may relate to your "blink rate"—how infrequently or incompletely people blink while looking at a screen.

Wearing Contact Lenses

Approximately 40% of people who wear soft contact lenses experience dry eye symptoms, especially later in the day when they've been wearing them for an extended period. Contact lenses can make your eyes feel more dry, but you may not notice it until you remove them at the end of the day.

Medications Linked to Dry Eyes

Certain medications may cause daytime or nighttime dry eye symptoms. Drugs linked to dry eyes include:

• Antidepressants
• Antihistamines
• Aspirin
• Certain types of blood pressure medications, including beta blockers and diuretics
• Hormone replacement therapy
• Nasal decongestants
• Oral birth control
• Seizure medications
  

How Dry Eyes Feel at Night

Having dry eyes at night could cause multiple sensations and symptoms. Or, you may have one or two of the symptoms below:

• Blurry vision
• Burning
• Discomfort wearing contact lenses and even after removing them
• Dryness
• Feeling as if something is in your eye(s)
• Light sensitivity
• Redness
• Tearing

How to Manage Symptoms at Night

There are several treatments you can try to manage dry eyes, such as:

• Use over-the-counter artificial tears: If you can, use preservative-free artificial tears. They cost a little more, but they are less likely to irritate your eyes than tears with preservatives. (Try a gel drop or ointment if tears do not help.)
• Reevaluate your environment: If a fan or air-conditioner blows wind toward your face while you sleep, it may be causing dry eyes. Also, remove dust on surfaces near your bed.
• Use a humidifier: A humidifier may counteract the effects of an air-conditioner or fan and provide more moisture to the air.
• Take regular breaks from screen use: The American Optometric Association's 20-20-20 rule can help. This means that every 20 minutes, take a 20-second break and look at something 20 feet away.
• Wear sunglasses outdoors: Sunglasses can help protect your eyes from dust, wind, and sun.
• Stay hydrated throughout the day: Insufficient hydration can cause various symptoms, including dry eyes.
• Remove your contact lenses at night: Remove your contacts to give your corneas (the dome-shaped front part of your eye) a chance to breathe.
• Apply a warm compress to the eyes: A warm (not hot), damp folded washcloth can help soothe dry eyes.

When Symptoms Warrant a Provider Visit

You may reach a point where you need to contact a healthcare provider, like an eye doctor, to help with your dry eye symptoms at night. Contact a provider if:

• Home-based treatments for dry eye don't relieve your symptoms.
  
• Home-based treatments provide only partial relief.
• Your symptoms worsen despite home-based treatments.

A healthcare provider can order prescription dry eye medications or, for severe cases, recommend procedures that will help you retain your own tears. This includes punctal plug insertion, in which an eye doctor uses a special tool to place a plug in the tear duct's opening. An eye doctor also can evaluate your eyes for ocular surface inflammation, which may contribute to your dry eyes.

Summary

Certain medications, aging, screen use, medical conditions, and your environment (such as exposure to dust or wind) can cause dry eyes at night, leading to symptoms like blurry vision, burning, dryness, excessive tearing, and sensitivity to light.

You can manage dry eyes by instilling artificial tears (preferably preservative-free), looking for and alleviating environmental triggers, using a humidifier, and taking regular screen breaks. If symptoms don't improve, contact a healthcare provider.