What causes dry eyes at night?

The eye has three layers of tear film: fatty oils, aqueous fluid, and mucus. Dry eye occurs when reduced tear production or increased tear evaporation throws off the balance of these layers, causing inflammation and irritation.

Common causes for tear production problems include:

• aging (most people over the age of 65 experience some dry eye)
• hormone changes, such as pregnancy, contraception use, or menopause
• certain health conditions, such as rheumatoid arthritis, diabetes, and thyroid issues
• inflammation of eyelid glands (a condition known as blepharitis)
• certain medications
• vitamin A deficiency
• dry air, wind, or smoke

If you notice your eyes are drier at night, there may be other factors at play. These may include:

• Nocturnal lagophthalmos. People with this condition don’t fully close their eyelids at night. Sometimes, the eyelids appear to close, but they don’t form a seal that holds in moisture.
• Screen time. Spending lots of time in front of your computer or smartphone reduces your blink rate. This can cause eye strain and dry eye, which may feel worse in the evening after a long day of work.
• Prolonged contact lens use. Wearing lenses for too long during the day can make dry eye more pronounced at night.

Natural remedies for dry eyes at night

Taking care of your health can help relieve nighttime dry eyes. There are also specific steps you can take to reduce symptoms.

• Apply a warm washcloth to your eyes. After a few minutes, gently rub the eyelids to remove dirt and irritants.
• Clean the eyelids. If you have blepharitis, you may benefit from regularly washing your eyelids with baby shampoo or mild soap. Apply a small amount to your fingertips and wash around the base of the eyelashes while your eyes are closed.
• Get more omega-3 fatty acids. Eating more foods that are high in omega-3 fatty acids, such as flax seed and fatty fish, may help ease dry eye symptoms. Or talk to your doctor about taking omega-3 supplements.
• Use castor oil drops. These drops may help reduce tear evaporation.
• Try acupuncture therapy. Some people have found that acupuncture helps reduce dry eye symptoms.

Treatments for dry eyes at night

If you have nighttime or early morning dry eye symptoms, talk with your doctor about other over-the-counter (OTC) or prescription remedies, such as:

• Artificial tears. Many people find that using OTC eye drops throughout the day helps to prevent dry eye. If you need to use drops more than four times a day, choose an option that doesn’t contain preservatives.
• Ointment or artificial tear gels. These help promote eye moisture and can offer longer relief than drops, but they may cause blurry vision. Use only a small amount of ointment at night to minimize this blurry effect.
• Prescription medications. If your doctor diagnoses you with dry eyes, they may prescribe a medication that reduces inflammation or increases tear production, such as:
  • antibiotics
  • cyclosporine (Restasis, Cequa)
  • corticosteroids
  • hydroxypropyl cellulose eye inserts (Lacrisert)
  • lifitegrast (Xiidra)
  • cholinergics (pilocarpine, cevimeline)

Waking up with dry eyes

An underlying medical cause or environmental factor can lead to the discomfort of morning dry eye. Take note if this happens regularly, and make an appointment with your eye doctor.

While you’re waiting for your appointment, assess whether any factors may be contributing to your dry eyes, such as screen time or contact lens use. You might also try using artificial tears during the day and warm compresses on your eyes at night.

Prevention tips

There are some simple things you can do to help prevent nighttime dry eye.

• Use a humidifier. Adding moisture to the air in your bedroom may help with nighttime dry eye, especially if your air is very dry.
• Reduce the impact of screens. If you spend a lot of time working in front of a computer, take frequent breaks and remember to blink often. It also helps to place your screen slightly below your line of vision.
• Change your eyewear. If you wear contacts, try switching to glasses.
• Wash bedding regularly. This removes allergens like dust and pet hair that might irritate your eyes.
• Stay hydrated. This helps your body have enough water to function properly and promote tear film.

When to see a doctor

Nighttime dry eye can signal a more serious condition. Talk with your doctor if you regularly experience dry eye, especially if lifestyle changes and artificial tears don’t help.

Your doctor may recommend other OTC treatments, prescribe medication, suggest further testing, or refer you to an optometrist for a more in-depth assessment.

The takeaway

Nighttime dry eye has many causes. Your doctor can help find the reason behind your symptoms. Taking breaks from your screen, wearing glasses instead of contacts, and using artificial tears may help reduce dry eye symptoms.

If you continue to have dry eyes after making these lifestyle changes, talk with your doctor. Medications may be necessary to provide long-term relief.

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