Cloudy vision when waking up

Specialty: Ophthalmology.

• transient morning visual clouding
• blurred vision when getting up

Why it occurs

• Meibomian gland dysfunction with posterior blepharitis (causes severe evaporative dry eyes and accumulation of dense lipids on the tear film during nocturnal eyelid closure)
• Morning corneal edema secondary to Fuchs corneal endothelial dystrophy (chronic endothelial dysfunction is exacerbated at night by lack of tear evaporation with the eye closed)
• Nocturnal lagophthalmos or incomplete eyelid closure during sleep
• Corneal epithelial basement membrane dystrophy (causes recurrent microscopic morning erosions)
• Chronic angle-closure glaucoma with blood pressure peaks in the late hours of the night

Initial workup

Corneal specular microscopy (to quantify the density, polymegetism and pleomorphism of endothelial cells); Quantitative ultrasonic corneal pachymetry (comparing values ​​taken early in the morning with those taken in the late afternoon, to document the degree of epithelial stromal dehydration); Tear Film Breakup Time (TBUT) with fluorescein staining; Measurement of intraocular pressure first thing in the morning.

Standard management

• 5% hypertonic sodium chloride — ophthalmic eye drops, apply 1 drop 4 to 6 times a day, and ophthalmic ointment formulation, apply a small amount to the conjunctival sac at night before sleeping; creates an osmotic gradient that dehydrates the corneal stroma reducing morning edema
• Sodium hyaluronate 0.4% in gel without preservatives — apply before sleeping as a surface protective lubricant
• Erythromycin (0.5% night ophthalmic ointment in case of recurrent corneal erosions to avoid infections).