Night product selection tips

Introduction

This article focuses on the use of shields, goggles, masks, patches and medical tapes that can provide moisture retention by providing a physical barrier over your eyes and/or by securing your eyelids closed. Other important elements of caring for your eyes before sleep include the use of proper lubrication and, if you have blepharitis or meibomian gland dysfunction, any evening lid care recommended by your doctor, such as warm compresses and good lid hygiene practices.

SEE ALSO: Night eye protection products - Comparison chart

1. What's your diagnosis?

And please, don't just say "Dry eye". If that's all you know, find out more before proceeding.

People who experience severe overnight dry eye symptoms do so for a variety of reasons, from poor tear production from auto-immune disease, to poor lipid production or chronic blepharitis, to poor eyelid closure. In most cases they seem to experience some amount of relief when using physical barrier protection over their eyes (in addition to lubrication and whatever medical treatments they are pursuing), almost regardless of their medical specifics - which is why moisture goggles and shields are so popular. However, there are many eye conditions that have implications for your product choice, and in these cases, it is particularly important that you involve your doctor in your choice (see #7 below).

Here are a handful of those conditions:

• Nocturnal lagophthalmos (incomplete eyelid closure at night): This common condition becomes more serious when you also have dry eye. When severe enough that lubrication doesn't help enough, you can block moving air with a mask or shield to reduce evaporative tear loss. You can attempt to force your lids down (often uncomfortable, sometimes unsafe). You can seal your eyes under a 'bubble' to trap moisture.
• Other eyelid closure issues such as Bell's palsy, ptosis, or the aftermath of acoustic neuroma surgery can pose high risks to the cornea from excessive exposure. Aggressive protection like taping the lids down may be necessary, so look for our advice on skin friendly tapes and hybrid strategies.
• Blepharitis / MGD: Goggles will probably help with symptoms, but it's important to treat the actual condition.
• Recurrent corneal erosions (RCE) / map dot fingerprint dystrophy (MDFD, ABMD: Classic symptoms of this condition are spontaneous abrasions to the surface of the cornea in the middle of the night or early morning, causing sudden very sharp pain, blurry vision and watery eyes.
• Glaucoma / elevated intraocular pressure: Often patients with these conditions are told by their doctors not to use moisture goggles that might put pressure on their eyes. That rules out Tranquileyes (the best-known moisture goggle), among other things, so it's important to know.
• Ocular allergy. If redness and puffiness, and/or itching, are part of your morning eye condition, and you have not been diagnosed with ocular allergies, this merits a conversation with your eye doctor. Keep in mind that your bedding can be a culprit. And while most night protection products are hypoallergenic, some people are sensitive to silicone, adhesives and foams.
• These are just examples, albeit common ones, to prompt more thinking, research and conversations with your doctor. 

2. BACK, SIDE or STOMACH sleeper?

Back sleepers will have the most choices, because they don't have to worry about things pressing on their eyes. Focus on getting the item that will provide the best protection and be the most comfortable.

Side sleepers need to consider, for each product, whether it will stay securely in place, whether any part of it may press on the eye on the side you're sleeping on (bearing in mind this will vary depending on how it fits you and whether you have prominent or deep set eyes), and whether any part may press uncomfortably into the skin and leave impressions. Look for things that aren't too slippery, and that are adjustable, or that have enough structure to prevent pressure on the eye.

Stomach sleepers need to be more safety conscious than anyone else. You need something that will stay quite securely in place, and you need to avoid anything that could be pressed onto the eyes, especially if your lids don't fully close at night. If you have floppy eyelid syndrome (FES), these are particularly serious concerns. Look for things that vault the eyes, have some stiffness or structure to them, and have secure straps. 

3. ONE or TWO EYES? 

The only products designed specifically for long term night dry eye protection (those made by Eye Eco) are made for two eyes. We sure hope this will change, but we've been asking for better single eye products for an awfully long time and they haven't come yet. So if you only have problems in one eye, you'll either need to get something designed for two eyes (we recommend the transparent ones) or you'll have to be wiling to accept the tradeoffs of products designed for temporary use, such as adhesives or less comfortable foam or edges.

4. Opaque or CLEAR?

If you want to be able to get up in the night without removing your eye protection, or need something you can put on before you don your CPAP, look for transparent items like Quartz, EyeSeals 4.0, post LASIK type shields and bubble bandages. It's important to note that ALL of these, if they fit you well enough to work, will fog up - moisture retention is the whole point. So don't expect good vision, but it's at least some vision.

Clear shields are, of course, the best choice for elderly or disabled users that may be at risk of falling when rising during the night. They are also a good choice for children with severe exposure issues.

5. CPAP mask compatibility?

For products where the answer isn't obvious, we generally have notes about CPAP compatibility in the notes. We're also happy to look up your mask model and tell you what we think about compatibility - though sometimes it depends on sizing and fit.

The most common answer, though, is that Quartz & Onyix silicone shields are compatible with virtually every CPAP mask; Eyeseals 4.0 is compatible with some, and may require modification; and Tranquileyes is only compatible with a few. If you can't visit a local provider of these goggles to be able to compare them, then we recommend purchasing two or more items and planning to return whatever doesn't fit.

6. DOCTOR'S ADVICE

Please make sure you always involve your doctor in this kind of decision. While we can provide guidance, we absolutely cannot take the place of your doctor in deciding what is safe or likely to be most effective for you. We are not doctors; we only know what you tell us, and there are sometimes specific eye conditions or factors that make a particular product a bad idea. Our role is to present possibilities - it's up to you to clear it with your doctor.

If you're wondering why this isn't the first item in my checklist, it's because so many eye doctors, including cornea specialist ophthalmologists, are simply not aware of the full range of product choices. Relatively few are thoroughly hands-on with this type of thing. Commonly, eye doctors will tell their patient either to "get a moisture goggle" or "tape their lids down". Less commonly, they will recommend a specific product.

I don't want to set patients up with the expectation that their doctor should figure out and tell them exactly what product they should use for this purpose, because that's not how they see their role. Truthfully, probably no one has the extent of experience with special night protection needs than we do here at the Dry Eye Shop. The bottom line is that YOU need to be your own best advocate (and we're happy to help!): do the research, narrow down the choices, and present your doctor with options, so that if they need to comment on your choice they can.

7. Are you an ADVOCATE for an elderly or disabled person?

Please call and ask for assistance. There are special safety factors to be considered for the elderly and for people in situations with third party caregivers (assisted living, group homes, etc). We want to help you find the safest, most effective and practical tools for your loved one.

8. Remember, it's all about trial & error, and benefits vs tradeoffs

There is no perfect night device. Everyone is different. Fit, comfort, moisture performance, skin sensitivities, sleep styles, tolerance for hassle factor, to say nothing of budget - these are just some of the things that may dictate what you will find beneficial and tolerable. We have a 30 day return policy on night protection products because we know you need to be able to experiment, and we encourage you to try more than one thing at a time so that you can make direct comparisons.

No dry eye protection strategy at night is universally tolerable and pleasant. Most people can't max out moisture overnight without some tradeoffs. For example, the best coverage is probably the sealed adhesive bubble bandages, but who wants to have adhesive around their eyes every night if they can possibly avoid it? So you need to find a balance of what gives you enough benefit to be worth it, but without interfering with your sleep or having other undesirable side effects on your skin. And keep an open mind about multiple products - many people rotate between different things, especially if their symptom severity varies with the time of year.

- Rebecca