Many people visit the eye doctor with a common complaint: "I feel like sand is in my eyes when I wake up in the morning." They complain that their eyes hurt, itch, burn, or feel gritty as if a small piece of sand or particle is stuck in their eye. They also complain of having a difficult time opening their eyes in the morning and seem to be very sensitive to light.
By the time they make it to the eye doctor, they have already purchased several types of over-the-counter eye drops trying to find some relief. Although sometimes the drops provide some short-term relief, most often the drops just sting or burn a little and don’t help all that much (and if they do help, the cycle just seems to start over again the next morning).
If you feel like your eyes are gritty and irritated, you may be suffering from a specific condition. The following four conditions can cause a gritty sensation in your eyes.
Dry Eye Syndrome
Dry eye syndrome often causes a sandy, gritty sensation in the morning that usually gets worse throughout the day. Dry eyes of varying severity can cause uncomfortable, irritating symptoms. If your eyes are dry, your eyes may burn much more than they itch. Your vision may also seem to fluctuate a lot and it may take awhile to have good, clear vision in the morning. Also, your eyes don’t produce as many tears during the night because your eyes are closed and the tear film is unstable and has a lack of quality and quantity.
Although artificial tears are a great start to treating dry eyes, what’s more important is the type and brand of artificial tear being used as specified by your eye doctor. It is important to see your eye doctor because sometimes eye drops are not enough. You may have to instill a gel or ointment into your eyes before you go to sleep at night for more protection. Your doctor may also recommend special prescription medications or eye procedures, such as punctal occlusion, for the treatment of your dry eye condition.
If you complain of sand in your eyes, your doctor might ask you if anyone, such as your spouse, has ever told you that you sleep with your eyes open. You may think your doctor is reaching too far with that question, but lagophthalmos is a common condition, especially in children.
In some people, the eyelids do not close all of the way, leaving the cornea of the eye exposed to the atmosphere all night long. Because you are not actively blinking, your eyes dry out considerably and an inflammation, called keratitis, develops. This can cause light sensitivity and a very strong sandy, gritty sensation in your eyes in the morning.
Lagophthalmos can be caused by a few different conditions. In children, it is usually an anatomical issue that is outgrown quickly. Lagophthalmos can also occur from cosmetic eyelid surgery that was slightly too aggressive. The skin may be raised or tightened too much, not allowing a full blink or a tight close while sleeping.
Other conditions, such as proptosis caused by thyroid eye disease, can also cause lagophthalmos. People with nocturnal lagophthalmos should not be afraid to move from eye drops toward using thicker eye ointments to speed healing and reduce symptoms.
Floppy Eyelid Syndrome
Floppy eyelid syndrome (FES) is a relatively uncommon condition characterized by loose upper eyelids that easily turn inside out. FES is typically seen in overweight, middle-aged males. Some people with FES also suffer from obstructive sleep apnea.
Occasionally, in people with FES, turning over while sleeping or accidentally moving a certain way on a pillow can inadvertently turn the eyelid inside out. Treatment for FES often includes artificial tears to reduce irritation and an antibiotic if signs of infection are present. Using tape or an eyeshield to keep the eyelids closed while sleeping may help keep the eyes from becoming dry.
Blepharitis is a group of conditions that affect the eyelashes, eyelids and eyelid glands. Blepharitis is commonly caused by bacteria that is present on the skin, but some people, due to age, skin changes or lack of good hygiene, tend to build up more of this bacteria on the eyelids. Sometimes the eyelid glands can become plugged or infected, causing meibomian gland dysfunction or eye styes.
Blepharitis tends to cause eye redness and inflammation. People with blepharitis may wake up in the morning with more crusty eyelids. Sometimes dried mucus can fall into the eye, causing irritation or a sandy gritty sensation.
What To DoIf you wake up more than once with a sandy, gritty feeling in your eyes, you should see your eye doctor as soon as possible. Your doctor may ask the following questions:
- Do you sleep with your eyes partially open?
- Are your symptoms worse upon awakening?
- Do your symptoms get better as the day goes by?
- Do you sleep under an air vent or ceiling fan?
Your doctor will examine your eyes under a slit lamp to look for signs of dryness or other signs of inflammation, such as keratitis. He or she will instill a special stain to see where on your eye the dryness or inflammation is occurring. The location of the staining will give your doctor clues as to the underlying causes of these symptoms.
Review of Optometry, "Like Sandpaper in the Morning". 15 April 2012, pp 75-77.