Why Morning Dry Eye Happens — The Clinical Causes and How to Fix It

Many people wake up with burning, gritty, or irritated eyes — even when their symptoms improve as the day goes on. This pattern is not random. Morning dry eye is often the result of what happens while you sleep, not what happens during the day.

One of the most overlooked contributors is Incomplete Lid Seal (ILS) — when the eyelids do not fully close at night, allowing continuous overnight evaporation. Below, we break down the clinical mechanisms behind morning dry eye, the medical conditions that increase risk, and why a physical eyelid seal like SleepTite SleepRite® can dramatically improve morning comfort.

Understanding Morning Dry Eye: What Happens Overnight

Reduced Tear Production at Night

During sleep, the lacrimal glands naturally produce fewer tears. The tear film becomes more dependent on:

• Proper eyelid closure

• A stable lipid layer

• Absence of airflow or exposure

Any disruption to these factors increases evaporation and leads to significant morning dryness.

Incomplete Lid Seal (ILS): A Primary and Underdiagnosed Cause

ILS occurs when the eyelids fail to fully close during sleep — even by a few millimeters. Research suggests that up to 20% of adults experience some level of nocturnal eyelid opening, often without realizing it.

When the eyelid seal is compromised:

• The tear film evaporates continuously

• The corneal surface dehydrates

• Inflammation increases

• Patients experience significant discomfort upon waking

ILS is a known driver of:

• Burning or stinging eyes in the morning

• Morning light sensitivity

• Eyelid “sticking” sensations

• Redness or irritation

• Excess tearing as a reflex to overnight dryness

Left unaddressed, chronic exposure during sleep can exacerbate dry eye disease and even contribute to exposure keratopathy.

Environmental Contributors to Morning Dry Eye

Airflow During Sleep

Even mild airflow accelerates tear evaporation, including:

• Ceiling fans

• Floor/desk fans

• Air conditioning or heating vents

• CPAP or BiPAP leaks

• Air purifiers directed near the face

Combined with the reduced tear production of sleep, any airflow can create significant morning dryness.

Sleep Position

Side and stomach sleeping increase mechanical distortion of the eyelids. Facial pressure on a pillow may:

• Pull eyelids slightly open

• Reduce lid seal integrity

• Create localized exposure zones

This is especially problematic in patients with loose lid anatomy, prior eyelid surgery, or mild facial nerve weakness.

Evening Screen Use

Reduced blinking before bed decreases the tear film’s stability. Patients often enter sleep with:

• A thinner aqueous layer

• A less robust lipid layer

• Increased surface inflammation

A compromised tear film is more vulnerable to overnight exposure.

Medical Conditions That Increase Morning Dry Eye Risk

Several diseases directly impact eyelid mechanics, blink function, or tear production — all of which worsen dryness overnight.

1. Bell’s Palsy

Bell’s palsy causes unilateral or bilateral facial nerve weakness, resulting in:

• Incomplete eyelid closure

• Reduced blink strength

• Lagophthalmos

Patients often wake with significant irritation in the affected eye due to overnight exposure.

2. Thyroid Eye Disease (TED) / Graves’ Ophthalmopathy

TED can cause:

• Proptosis (eye protrusion)

• Eyelid retraction

• Reduced blink completeness

These anatomical changes prevent the eyelids from forming a protective seal, making morning dry eye one of the most common complaints.

3. Lagophthalmos (Nocturnal or Persistent)

Lagophthalmos — the inability to fully close the eyelids — is directly associated with:

• Exposure keratopathy

• Tear film evaporation

• Increased corneal staining

It may be caused by:

• Prior blepharoplasty

• Eyelid scarring

• Nerve damage

• Facial trauma

• Mechanical changes from aging

Even mild lagophthalmos can produce severe morning dryness.

4. Facial Nerve Paralysis or Weakness

Any condition affecting cranial nerve VII can reduce blink quality and eyelid closure, including:

• Post-stroke weakness

• Tumors

• Ramsay Hunt syndrome

• Neuromuscular disorders

• Surgical injury

These patients often present with unilateral morning dry eye.

5. Eyelid Malpositions

Structural lid issues significantly impair nocturnal protection:

• Ectropion: lower lid turns outward

• Entropion: inward turning causing irritation

• Floppy Eyelid Syndrome: lids easily evert during sleep

Each of these conditions compromises the eyelid’s ability to maintain a tight seal.

6. Autoimmune Disorders

Autoimmune diseases impact both tear quantity and quality:

• Sjogren’s Syndrome — severe aqueous tear deficiency

• Rheumatoid Arthritis — inflammation affecting tear glands

• Lupus — systemic inflammatory effects

• Ocular Rosacea — meibomian gland dysfunction

Patients with autoimmune dry eye often experience the most severe morning symptoms.

7. Diabetes

Diabetes is associated with:

• Reduced corneal sensitivity

• Autonomic neuropathy affecting blink reflex

• Accelerated tear evaporation

These changes heighten overnight dryness and morning irritation.

8. CPAP or BiPAP Air Leakage

CPAP users frequently report:

• Air leaking toward the eyes

• Mask pressure altering eyelid position

• Sleep fragmentation due to eye irritation

This airflow dramatically increases evaporation throughout the night.

Why Treating the Nighttime Cause Improves Daytime Comfort

If the underlying issue occurs overnight, daytime drops and treatments offer limited relief.

Patients often describe the cycle:

“My eyes feel terrible in the morning, then better as the day goes on — until it starts all over again.”

This is the hallmark of nighttime exposure.

To break the cycle, the tear film must be protected overnight, and the eyelids must remain fully closed.

How SleepTite SleepRite® Lid Seals Help

SleepTite SleepRite is designed to address the root cause of morning dry eye: inadequate nighttime eyelid closure and overnight evaporation.

Clinically aligned benefits:

✔ Provides a gentle, secure seal to keep eyelids fully closed
✔ Reduces overnight exposure and evaporation
✔ Stabilizes the tear film
✔ Protects against environmental airflow
✔ Supports corneal healing by maintaining moisture
✔ Helps patients with ILS, lagophthalmos, Bell’s palsy, and facial nerve issues
✔ Aids CPAP users who experience air leaks toward the eyes

The seals work externally, without medications or ointments, and offer consistent nightly protection.

Available in Two Versions:

• Regular — ideal for most users

• Sensitive — for those with known adhesive sensitivities or delicate skin

For the majority of patients, Regular provides the best adhesion and overnight seal unless a specific adhesive allergy is known.

When to Consider SleepTite SleepRite Lid Seals

Patients may benefit if they experience:

• Morning burning, stinging, or pain

• Eyes that feel “stuck” or irritated upon waking

• Dependence on immediate morning artificial tears

• Morning light sensitivity

• CPAP-related irritation

• A partner noticing their eyes open during sleep

Even mild symptoms can indicate nocturnal exposure.

Morning dry eye is frequently a sign of nighttime tear film exposure, often driven by Incomplete Lid Seal (ILS), airflow, medical conditions, or anatomical factors. Because tear production decreases naturally during sleep, the eye depends heavily on complete eyelid closure for protection.

A simple, supportive solution like SleepTite SleepRite® Lid Seals helps address the root cause by ensuring the eyelids stay comfortably closed, allowing the ocular surface to remain hydrated throughout the night — so patients can wake with calm, comforted, and refreshed eyes.