From the Guidelines
To effectively manage morning dry eye syndrome, using artificial tears or lubricating eye drops immediately upon waking is crucial, as evidenced by the most recent guidelines 1. This approach is supported by the dry eye syndrome preferred practice pattern, which suggests that patients with suggestive symptoms without signs should be placed on trial treatments with artificial tears when other potential causes of ocular irritation have been eliminated. Key considerations include:
- Applying 1-2 drops in each eye before getting out of bed with brands like Systane, Refresh, or GenTeal being effective options 1.
- Using a humidifier in the bedroom to add moisture to the air while sleeping, aiming for 30-50% humidity, to prevent eyes from drying out overnight.
- Considering preservative-free artificial tears for frequent use, as preservatives can irritate eyes with long-term use 1.
- For severe cases, an ophthalmologist may recommend nighttime ointments or prescription eye drops like Restasis or Xiidra, as outlined in the guidelines for severe dry eye treatment 1. These methods are effective because dry eyes often result from decreased tear production during sleep or increased tear evaporation in dry environments, and consistent use of these strategies can significantly improve morning eye comfort. It's also important to address potentially exacerbating factors such as antihistamine or diuretic use, cigarette smoking, and environmental factors like air drafts and low-humidity environments, as these can worsen dry eye symptoms 1. In cases where dry eye syndrome is associated with systemic immunological disorders or the use of systemic medications, evaluation by an ophthalmologist is crucial for appropriate diagnosis and management, especially in circumstances like moderate or severe pain, lack of response to therapy, or vision loss 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Invert the unit dose vial a few times to obtain a uniform, white, opaque emulsion before using. Instill one drop of RESTASIS® ophthalmic emulsion twice a day in each eye approximately 12 hours apart. RESTASIS® can be used concomitantly with artificial tears, allowing a 15 minute interval between products. Discard vial immediately after use. The treatment for morning dry eye syndrome is not explicitly mentioned, but RESTASIS® ophthalmic emulsion can be used to treat dry eye. The recommended dosage is one drop twice a day in each eye, approximately 12 hours apart. It can be used with artificial tears, allowing a 15 minute interval between products 2.
From the Research
Treatment for Morning Dry Eye Syndrome
The treatment for morning dry eye syndrome typically involves the use of artificial tears to moisturize the ocular surface and reduce damage to the corneal epithelium.
- Artificial tears are the first line of therapy for dry eye disease (DED) and are also the most frequently used treatment approach for this common condition 3.
- The use of gels at night-time, which are more viscous and have a longer ocular surface retention time than artificial tears, can help relieve more severe symptomatology 4.
- Fixed dosing of artificial tears (four times daily) may provide better symptomatic relief than as-needed dosing, although the difference in ocular staining between the two dosing regimens was not significant 5.
- Over-the-counter (OTC) artificial tears may be safe and effective means for treating dry eye syndrome, but the literature indicates that the majority of OTC artificial tears may have similar efficacies 6.
Types of Artificial Tears
Different types of artificial tears may have varying effects on the treatment of dry eye syndrome.
- Some artificial tears, such as 0.2% polyacrylic acid-based artificial tears, may be more effective at treating dry eye symptoms than others, such as 1.4% polyvinyl alcohol-based artificial tears 6.
- Artificial tears acting primarily on the internal and intermediate layer of the tear film may lead to a mild decline in lachrymal production, while those acting on the lipidic layer may increase the average tear break-up time (TBUT) 7.
- An association of different kinds of artificial tears acting on each layer of the tear film may be the best treatment for corneal surface diseases affecting eye lubrication 7.