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    How sleep affects the ocular surface

    Insufficient or poor sleep may play role in ocular health


    This begs the question: Should ODs incorporate a sleep survey into their dry eye exams?

    Akin to dry eye disease, there are numerous validated global and targeted patient sleep/sleepiness/insomnia questionnaires available. Questionnaires can be selected to help identify sleep disorders in subsets of patients such as pediatric, adolescent, adult patients, or obstructive sleep apnea suspects.

    With novel technologies and emerging discovery, our evaluation of the OSD patient has become more sophisticated and fine-tuned. Each snippet of information supplements the profile of individual dry eye patients and adds a target for therapeutic intervention.

    One prescription we should possibly include is lid and sleep hygiene. Patient sleep survey results may add the extra clinical sign/symptom that may be the tipping point for our OSD patients.

    Related: How hygiene products affect ocular surface and lids


    1. Centers for Disease Control and Prevention. Sleep and Sleep Disorders. Available at: https://www.cdc.gov/sleep/index.html. Accessed 6/6/17.

    2. Haji-Ali-Nili N, Khoshzaban F, Karimi M. Lifestyle Determinants on Prevention and Improvement of Dry Eye Disease from the Perspective of Iranian Traditional Medicine. Iran J Med Sci. 2016 May;41(3):S39.

    3. Kawashima M, Uchino M, Yokoi N, Uchino Y, Dogru M, Komuro A, Sonomura Y, Kato H, Kinoshita S, Tsubota K. The association of sleep quality with dry eye disease: the Osaka study. Clin Ophthalmol. 2016 Jun 1;10:1015-21.

    4. Mastrota KM. Impact of floppy eyelid syndrome in ocular surface and dry eye disease. Optom Vis Sci. 2008 Sep;85(9):814-6.

    5. Ong ES, Alghamdi YA, Levitt RC, McClellan AL, Lewis G, Sarantopoulos CD, Felix ER, Galor A. Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans. JAMA Ophthalmol. 2016 Dec 22. doi: 10.1001/jamaophthalmol.2016.4925. [Epub ahead of print]

    6. Alevi D, Perry HD, Wedel A, Rosenberg E, Alevi L, Donnenfeld ED. Effect of Sleep Position on the Ocular Surface. Cornea. 2017 May;36(5):567-571.

    7. Martinez-Ramirez D, De Jesus S, Walz R, Cervantes-Arriaga A, Peng-Chen Z, Okun MS, Alatriste-Booth V, Rodríguez-Violante M. A Polysomnographic Study of Parkinson’s Disease Sleep Architecture. Parkinsons Dis. 2015;2015:570375.

    8. Nowacka B, Lubinski W, Honczarenko K, Potemkowski A, Safranow K. Ophthalmological features of Parkinson disease. Med Sci Monit. 2014 Nov 11;20:2243-9.

    9. Buysse DJ, Reynolds C, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193–213.

    10. Centers for Disease Control and Prevention. MMWR. 2011 March 4;60(8):234-266. Available at: http://www.cdc.gov/mmwr/PDF/wk/mm6008.pdf. Accessed 6/6/17.

    11. Centers for Disease Control and Prevention. Insufficient Sleep is a Public Health Problem. Available at: http://www.cdc.gov/features/dssleep/. Accessed 6/6/2017.

    12. National Sleep Foundation. Healthy Sleep Tips. Available at: https://sleepfoundation.org/excessivesleepiness/sleep-tools-tips/healthy-sleep-tips. Accessed 6/6/2017.

    Read more from Dr. Mastrota here

    Katherine M. Mastrota, MS, OD, FAAO, Dipl ABO
    Director of Optometry, New York Hotel Trades Council, Hotel Association of New York City, Health Center, Inc.


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