Do you have “Mom’s” (or Dad’s) eyes?
Do you have “Mom’s” (or Dad’s) eyes?
If you wake up feeling more dry, gritty or scratchy in the morning than when you went to bed at night, then you very well may!
OK, most of us will see an image of our parent’s face staring back from our mirrors at some stage of our life - but that isn’t exactly what I’m referring to.. Whether or not you are a mom (or dad) – you had a mom (and dad) – and chances are, it seemed like they were never really sleeping when you crept in at night. It was like you could never get away with anything because it seemed like they were always “awake.” For that reason, when patients complain that they feel drier on waking, I perform a “Korb-Blackie Nocturnal-Lagophthalmous light (NL) test” to see if they may be sleeping with eyes open (and why, if they do, I call this “mom’s eyes.”).
NL or “Nocturnal Lagophthalmous” describes the not-uncommon tendency to sleep with eyelids slightly “open.” In the light test described by Drs. Korb and Blackie, the room is dim and the light on the slit-lamp (eye exam microscope) is turned off as your eyes are examined. To illuminate, a small flashlight that focuses its light from the tip of a small, finger-like extension allows the examiner to shine a light at - and through - (transilluminating) the eyelids. When the lower lid is rolled over the light, the examiner can see the Meibomian Glands (the eyelid oil glands) in good detail – but when the examiner asks you to gently close your eyes “as if you are sleeping,” then the light is aimed through the upper lid, downwards. This creates a chance to see any gap between the lids as a pink line. The thicker the line, the more open the lids and the more exposure of the eyeball.
Naturally the patient is not truly “asleep,” so a certain amount of this diagnosis is conjecture. However, the likelihood runs high in my clinical estimation. So how does this happen and why should we care?
If you sneak up on a sleeping child, it is not uncommon to see a slight gap between their eyelids (perhaps they are preparing to be parents much later in life;). They generally can get away with it, as their young eyes are usually so healthy and their tears “swimming” in such great oil, that the oil floating on top of their tears “coats” the tear and blocks evaporation. Early in life, they also probably have yet to “learn” incomplete blinking (though with digital device exposure at ever earlier ages, kids seem to be learning this problem all to soon). Once the lids cover the pupil, light is blocked and the brain can sense the eyes as “closed,” even when less than fully touching upper and lower lids together – causing NL.
As we age, it is all too common to train the Meibomian Glands to “not work” by doing “poor” (weak) or “partial” (incomplete) blinks. Add to that the modern American diet that is said to be 95 times less rich in the healthy Omega’s 3-6-9 oils (the building blocks of all the “good oils” in a human – and especially those of our tear oils) than just 100 years ago. For that we can thank processed foods (all the tasty stuff like corn-fed animal meats, white breads, pastas, etc). Remember that the best sources of these oils come from Fish, Tree Nuts and Seeds. Once we allow the MGs to clog up with poor oils and poor blinking (only strong blinks pump oils from the glands), then we lack good oils in our tears – and evaporation is inevitable.
When sleeping with poor oils and slightly open lids, then evaporation can leave eyes drier on waking. Evaporation leaves higher levels of salts and crusty proteins that are irritating, and irritation can lead to inflammation – which leads to more dryness. Waking up dry is like waking up on the wrong side of the bed. You’re off to a “bad start.” Some “work arounds” include drinking more water at bedtime (though this may lead to bathroom interruptions when you’re trying to sleep), using a humidifier close to your bed (so there is less dryness in the air that would otherwise aide evaporation) – or going to bed with ointments or gels in your eyes. Some patients wake up several times at night to reinstall artificial tears. While this can reduce evaporation and aide in lubrication – the artificial tears, oils and gels available today are not even close to the complex, healthy oils that would ordinarily be a part of good tears. It also covers up (think Band-Aide) the relentless progression of the Meibomian Gland Dysfunction (MGD) that is like “kicking the can down the road” rather than properly addressing and hopefully fixing the MGD problem.
My usual “fix” is to start by reducing evaporation by creating a “terrarium” over the sleeper’s eyes. This can be as simple as using a plastic wrap under some type of sleep mask to hold it in place – or using a “Press N Seal” type of plastic which has a sticky surface on one side to help hold it in place. This allows many patients to try a simple, low-cost option (playing Sherlock Holmes) to see if this allows them a chance to wake up on the “right side” of the bed. If this appears to help, then the diagnosis is more secure. In most cases, patients will prefer to invest in a $50-60 pair of “sleep goggles” that are simpler to apply and easier to remove for those trips to the bathroom (many options exist, but the eyeeco brand https://www.eyeeco.com has several good ones to choose from).
Following the terrarium approach, I think it is vital to properly diagnose and treat the degree of MGD causing the increasing symptoms of the problem (NL). Good tears can mean better sleep, better comfort, better vision, and a better appearance (less tired, red, dry or reflex-teary eyes). As usual, it is always better to check with your dry eye specialist to see what is best for you.