Two eyes walk into a bar – after sitting down, one eye says to the other “between the two of us, something smells!”

erosion

Alcohol is known to cause decreased visual performance with slow pupil reactions, less peripheral vision and lower contrast sensitivity. Most people assume that alcohol only affects your eyes while you’re drunk, but that hangover can be doubly tough when you wake up with sudden eye pain.

I have a patient who likes to have ‘fun,’ but this fun oftentimes comes with red painful eyes the next morning. After researching his condition, I learned that alcohol can cause and exacerbate a condition called “Drinker’s Eye,” a type of recurrent corneal erosion that leaves patients regretting last night’s decisions.

There is almost no literature linking late night drinking with eye pain, but the link is clear if you look at the evidence. First, a little background:

cornea

Often times I describe the cornea to a patient in simple terms they can understand. Basically, there are three layers to this clear front surface of the eye: an outermost ‘skin’ type later, a middle ‘meaty’ layer and the inside layer that pumps in nutrients. A condition called Recurrent Corneal Erosion (RCE) happens when the outermost ‘skin’ layer doesn’t adhere, or tack-down, to the ‘meaty’ tissue underneath.

Now, when we sleep, our eyes actually swell a bit and come into contact with the inside of our eyelids, and there is some level of ‘stickiness’ or adhesion between the eye and the lid. The dryer the eye, the more adhesion takes place. When an eye with a healthy cornea opens in the morning, the adhesion breaks off uneventfully. But when the top layer of the cornea isn’t tacked down properly, the ‘skin’ cells rip off when the eye opens- causing acute pain and discomfort lasting hours into the day.

What ultimately results is a corneal abrasion – a serious eye problem that may require antibiotics and an bandage.

RCE is a recurrent condition, meaning it usually doesn’t just happen once, but instead over and over with days, months or years in between. This all stems for some problem with the bond between the corneal layers – usually there was an underlying initial injury that just didn’t heal correctly. Another cause could be a corneal dystrophy called map-dot-fingerprint dystrophy.

So back to alcohol. We know alcohol causes dehydration and dehydration causes dry eyes. We also know that dry eyes leads to a higher eye-to-lid adhesion while sleeping. So it’s not a stretch to surmise that eyes with an underlying problem would be more prone to RCE after a night of drinking.

If this happens to you, there are a few steps you can take to avoid calling me on a Sunday with an emergency eye condition. First (and most obviously), don’t drink as much! Less alcohol will lead to less problems.

Secondly, if you can remember (keep in mind you’ve been drinking) put in a lubricating eye drop before bed. Preferably a gel or ointment that will lubricate your eye all night and cut down on the stickiness between the eye and the lid.

Lastly, drink more water to hydrate before you go to sleep. Pretty sound advice for any drinker, but even more so if your eye takes the brunt of the hangover.

More advice for suffers of RCE:

Environmental

  • Ensure that the air is humidified rather than dry, not overheated and without excessive airflow over the face. Also avoiding irritants such as cigarette smoke
  • Use of protective glasses especially when gardening or playing with children (to prevent injury)

General personal measures

  • Maintain general hydration levels with adequate fluid intake
  • Don’t sleep-in late as the cornea tends to dry out the longer the eyelids are closed

Pre-bed routine

  • Routine use of long-lasting eye ointments applied before going to bed
  • Occasional use of the anti-inflammatory eyedrop (prescribed by an ophthalmologist or optometrist) before going to bed if the affected eye feels inflamed, dry or gritty
  • Use of a hyperosmotic ointment before bed reduces the amount of water in the epithelium, strengthening its structure

Waking options

  • Learn to wakeup with eyes closed and still and keeping artificial tear drops within reach so that they may be squirted under the inner corner of the eyelids if the eyes feel uncomfortable
  • It has also been suggested that the eyelids should be rubbed gently, or pulled slowly open with your fingers, before trying to open them, or keeping the affected eye closed while “looking” left and right to help spread lubricating tears. If the patient’s eyelids feel stuck to the cornea on waking and no intense pain is present, use a fingertip to press firmly on the eyelid to push the eye’s natural lubricants onto the affected area. This procedure frees the eyelid from the cornea and prevents tearing of the cornea