Optician India

Welcome to question of the day #39

Why do patients sometimes complain of eyes that burn and itch in the morning?

This is often associated with excess ‘sleep’ and lash debris. It almost always involves marginal blepharitis and meibomian gland dysfunction, with an associated tear film instability.

Emphasize slit-lamp evaluation of the cornea and look for:

Inferior corneal hazing

Small fascicular pannus ingrowths or ‘ghosts’

Punctate fluorescein staining

Rapid tear breakup times.

Management

Lubrication and lavage especially at bedtime (use viscous drops) and immediately upon waking(use several drops of non-viscous solution)

Emphasize value of lid hygiene (lid scrubs)

Emphasize value of hot pack applications

Consider diagnostic punctal occlusion with collagen plugs

Consider more permanent occlusion if signs and symptoms are significantly improved

Consider oral tetracycline if the staining is severe.