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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I've been having some occasional morning blurriness in one

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Hi, I've been having some occasional morning blurriness in one eye. I'm 35. It usually lasts about 2.5 hours and slowly improves over that time. This has happened approximately 5 times over the last 3 months. I have been to an ophthalmologist and was found to have very mild farsightedness. There is no pain, no history of diabetes/glaucoma or high blood pressure. The blurriness can be quite bad at times and is very distracting.
Thank you for any help!

Hello and thanks for your question. So I think there are a couple of things that may be going on.

First, and less likely than the second option I will discuss in a minute, is a problem with the cornea. Some people have a condition where the cells in the cornea that are responsible for pumping water out of the cornea (to keep it clear and consequently providing clear vision) do not work so well. Then, when the eyes are closed all night, there has been no evaporation of water from the cornea through the air (which normally takes place during the day). The combination of these two things can cause this build-up of fluid which is worst first thing in the morning, but tends to dissipate after a few hours of the eyes being open mostly. This is called Fuchs Endothelial Corneal Dystrophy. Unfortunately, though, this is something that can only be diagnosed by an ophthalmologist once an exam of your eyes is done.

Second, when a person has cloudy vision either early in the day or it gets worse throughout during the day, it is often due to a tear-film deficiency, or a problem with the layer of tears that coats the front of the eye. This can lead to dry eye which can cause this cloudiness. When the eye is spending more of its time open than closed (as what happens as the day progresses), then this dry eye can become exacerbated.

In my practice, one of the most common causes of dry eyes that I see that is overlooked time after time by some eye doctors is an inflammation of the eyelid called blepharitis. There are many potential causes for dry eyes and there can be several causes active in the same patient. And then, even if one or two causes are treated, but one is not (such as blepharitis), the eyes still do not do well and it could make the other treatment seem as though they don't work, when they just aren't treating all of the causes.

First of all, blepharitis is an inflammation of the eyelids. The eyelids are key players in making a layer of tears that coats the surface of your eyes called a tear film. The inflammation keeps the eyelids from making that tear film as healthy as it needs to be and so the eyes dry out. Also because there is inflammation in the tears because of the blepharitis, there are bacteria pooling in your tear film. Often times an antibiotic +/- steroid drop or ointment is used to help kill the bacteria. This therapy is usually only used in a pulse fashion, to start out the treatment and then only used when there are flare-ups, not on a regular basis for most people.

Secondly, in order to treat blepharitis, everyday in the morning you should do two things: 1. hot compresses and 2. eyelid scrubs. You should do hot compresses for 5-10 minutes over each eye at the same time. It should be as hot as you can tolerate without burning your skin, massaging the eyelids while they are on there. Then, use either commercially available preparations or a dilute baby shampoo solution to scrub your eyelashes on all 4 eyelids. The commercially available preparations are called Ocusoft or Sterilid which are both over-the-counter eyelash scrubbing treatments. These cost more money but are quicker to use. Otherwise, the cheaper alternative is the dilute baby shampoo (4-5 drops Johnson's shampoo in 1/4 cup warm water), you will take the wipe (or dip a qtip in the dilute baby shampoo solution) and use that to scrub right on the eyelashes of each eyelid for 15 seconds. That will take 60 seconds when done to all 4 eyelids. The scrubbing is done right on the eyelid margin, where the eyelashes come out. After that, just splash some water on the eyes and you're done.

It does take about 3-4 weeks of doing this consistently every day before it really kicks in, so don't stop it thinking it's not working. Also the eyes are still significantly dry during this 3-4 weeks so use the artificial tears you bought 4x/day in both eyes (one drop per application). After 4 weeks you should be able to start tapering off of the tears to as you need them.

If you want to start the treatment for blepharitis, it is fairly easy and inexpensive to do, and it also is low-risk; this really won't harm your eyes in any significant way and may actually help them if this is what is happening. If you do start this treatment and after 2-3 weeks you see no change in your symptoms, then I would suggest a visit to your ophthalmologist's office for that exam.

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed?

I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Customer: replied 6 years ago.
Thank you for your answer! I did have a couple of follow-up questions.
Are there any outward signs of blepharitis? My eyelid doesn't feel inflamed to me, but I imagine it only takes a minor amount to cause problems.
Is there a reason for the seemingly randomness of this occurring. (having no problem for days or even weeks)?
I have an older sister with MS. Her initial symptoms were visual in nature. I realize its a big jump from a blurry eye to MS, but is that something I should evaluated for?
Once again thanks for your help.

You are correct, it can be subtle enough that there may be no signs. Some people have burning or irritation of their eyes in the morning, have mattering or crusting on their eyelashes in the morning, itching of the eyelids/lashes, or red eyes.

The randomness of it all speaks to it being a tear film abnormality, more likely, than the corneal problem. There are many things that can affect the tear film, including hormonal (menstruation cycle), environmental allergies, the weather, medicines that we may take, contact lens use, etc...For these reasons, it can certainly cause this to be random.

You bring up a good question about the MS. I wouldn't necessarily worry about MS right now. Usually when there is blurry vision associated with MS then it is a concrete event where the vision in one eye only gets significantly and permanently affected--when there is an optic neuritis (damage to the optic nerve from MS), then this is quite noticeable and doesn't present with transient, mild blurring.

Does that make sense?

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