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Dry Eye and Sleep Position

Dry eye disease is a common eye condition, affecting an estimated 40% of patients receiving ophthalmic care. It is defined by a reduced quality and/or quantity of tears to properly lubricate and protect the ocular surface, leading to chronic inflammation and irritation. The severity and frequency of these symptoms can range from mild and intermittent in nature to severe and disabling.

Sylvia, a patient of Eye Surgeons Associates since 2010, has lived with dry eye that began as a result of managing the skin condition, rosacea. Symptoms of rosacea are stinging and burning, reddened skin, and is often treated with tetracycline.

“I had so much discomfort in my eyes. I tried over-the-counter eye drops and didn’t feel any relief,” Sylvia recalls. “I live in Savanna so I went to Freeport to see a doctor there. That just didn’t work out well for me. Then I saw a commercial on television about Eye Surgeons and just hoped that someone could help me out. That’s when I started seeing Dr. Boehm in Bettendorf.”

For a while it felt like nothing was going to help her discomfort and she truly relished her eyesight. Sylvia and Dr. Boehm met every six months and started first with a punctal plug procedure, where a tiny plug is inserted into a tear drain opening in the lid, which can keep tears on the eye’s surface by slowing the rate of drainage from the eye. It helped for a bit but then additional options were needed. Eventually she would be prescribed Xiidra drops and fell in love with them.

“I noticed an immediate difference once starting to take the Xiidra drops. If you miss even just one dose, the dry eye symptoms will immediately return. I’m so glad this works because now I can sit in my car with the heater or air conditioning on and not worry about the air blowing on my eyes and causing instant irritation,” Sylvia exclaims.

Multiple factors causing or contributing to dry eye disease have been identified including: age, hormone changes, systemic disease such as Sjogren’s syndrome, side effects of systemic medications and environmental conditions. However, one recent study proposes a new risk factor in dry eye disease: a patient’s sleep position.

In a study published in Cornea, investigators found that those patients who sleep face down or on their side were more likely to have dry eye disease. The authors hypothesize that the link between sleep position and dry eye disease involves the oil glands in the eyelid, which secrete the oil component of tears. Patients who slept on their face or side were mechanically clogging their oil glands in the eyelids, leading to chronic inflammation and worsening dry eye signs and symptoms. Their study found that those patients who slept on their back had less ocular surface disease on exam compared to those patients who slept on their side. Similarly, those patients who slept on their side more likely had an elevated Ocular Surface Disease Index (OSDI) score, a standard survey used to assess the severity of dry eye symptoms and noted that for those patients who slept on their side, their dry eye disease was worse on the side that they slept on.

While the authors admit that it may be difficult to force patients to change their sleeping habits, an awareness of this association may help diagnose one possible cause of dry eye disease. Communicating with your doctor about your symptoms is critical in getting relief.

“I didn’t think Dr. Boehm was going to find something to help me because, at first, it felt like we weren’t getting anywhere. But he really cares about your eyesight. Don’t be afraid to ask questions and get all the information you can. I was desparate for my eyes to calm down and we just kept trying options until something worked.” Sylvia recalls. “Everyone at Eye Surgeons is helpful and wonderful and full of smiles. I just love being able to rely on them to help me.”

BIO: Michael Boehm, M.D. is a board certified comprehensive ophthalmologist at Eye Surgeons Associates with a fellowship in cornea and external diseases and a specialty interest in dry eye. Dr. Boehm practices at our offices in Bettendorf, Silvis and Rock Island. Eye Surgeons is an Accredited Dry Eye Center.

The material contained in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider.

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