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Subspecialties Cornea / Ocular Surface, Health Economics and Policy

After Dark

For years, dry eye specialists have encountered patients whose symptom severity is conspicuously worse in the morning. In response, we developed practical tips to help patients avoid desiccating stresses at night. These recommendations frequently involve instructing the patient to avoid turbulent air across the faces (fans, AC, forced air heat), allergens and mites. Many of these patients follow our instructions diligently and still wake up dry, inflamed and in pain. Fortunately, in recent years, we’ve gained important insight into several of the underlying mechanisms contributing to this problem. We have subsequently identified nocturnal lagophthalmos – or insufficient eyelid seal – as a more prevalent and influential compounding factor than previously believed.

It is only by recognizing and minimizing the impact of nocturnal lagophthalmos that a protective ocular surface environment can be recreated.

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About the Author

Laura M. Periman

Director of Dry Eye Services and Clinical Research at the Dry Eye Clinic, Seattle, WA, USA.

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