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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.