Eyeball pain while sleeping

I am 55.  During I sleep in morning, I feel sharp pain in my left eye.  I wake up and my eye hurts rather badly.  It would hurt if I touch it.  I blink it to get some relieving but blinking does not help.  I see redness in it. The pain and redness go away in a minute or so after the water came out of it.  The pain does not occur every morning but once a while.  I saw my eye doctor.  He said that it was very dry because I opened my eyes while sleeping.  And CPAP might cause my eye very dry that caused real pain.  So I wore the eye sleeping patch but the pain occurred under the patch.  This week one early morning I removed my CPAP when I needed to go to the pot.  I went back to bed but I did not put CPAP back.  I went back to sleep.  Two hours later the pain stabbed my eyeball and this time I was aware when it hurt before I opened my eyelids.  Now I know I do not sleep with eyes open.  There is something else new.  I noticed whiteness on my tongue just this week.  What do the pain in eyeball and white tongue try to tell me?  I become more concerned.  I will call my doctors but I would appreciate it if you know what possible causes the pain in eyeball. Thank you.

[John C Hagan III, MD, FACS, FAAO]

CPAP indeed can cause drying of the cornea and "recurrent erosion syndrome".

This is information from a previous post:

You have "recurrent corneal erosion syndrome". The condition is common and will not destroy your sight or cause serious loss of vision. It has been discussed in the past in the eye care forums. It usually starts after a scratched cornea that does not heal properly. In some instances it occurs due to a common disease of the outer layer of the cornea (basement membrane disorder). Use the search feature and type in "corneal erosions".

Here is part of a recent post on the problem:

Recurrent corneal erosions are the bane of the practice of ophthalmology for both the ophthalmologist (Eye MD) and the poor patient. I saw 2 of them in the office today. They can be very difficult and recalcitrant to treat. Not infrequently they are controlled with drops and ointments but reoccur if these medications are stopped. I'm sure you're well versed on the medical and preventive treatment of corneal erosions.

Treatment is to avoid anything that dries the eye. So keep it moist with artificial tears. At bedtime a lubricating drop with normal saline (Muro 128 ointment---available over the counter) is put in the eye.  Extreme care must be used in the morning on awakening as this is when the tissue usually tears. Avoid rubbing the eye. If the eye wants to stay shut from the ointment leave it shut, splash with warm water till it opens then put in an artificial tear or Muro 128 DROPS (available as 2% or 5% [which often stings] also available over the counter. If Muro 128 products are irritation try Refresh-PM ointment at bedtime and a good artificial tear on awakening and several times during the day (Systane, Opteve, Soothe, Refresh, Tears Naturale, etc).

Long plane and car trips are very stressing for corneal erosions. In the car, run the air conditioner or heater on the feet vents not into the face. Put artificial tears in the eye every couple of hours on a car trip and every hour on a plane trip.

You should go a minimum of 4 months without any pain from the erosion (usually during sleep or upon wakening) before trying to stop the ointment. Be aware that some people are never able to stop the medications and must use drops, ointments and precautions indefinitely (years and years).

The next step is often corneal stromal micro-punctures. This is an office procedure done with just eye drop anesthesia; a bandage contact lens is put in the eye for several days. You may return to normal physical activities immediately.  

If the problem persists then you may need to discuss these treatments with your ophthalmologist. He/she should be able to do the first method. The second he/she may or may not be able to do, sometimes referral to a cornea specialist is indicated.

1. There is a new method of treatment when all else fails. It involves taking oral tetracycline for a couple of weeks coupled with steroid eye drops. If your ophthalmologist is not familiar with the method he/she can do a literature search of the medical ophthalmology journals. The first time I read of it was in the journal "Ophthalmology". I have used this method on two patients that were "at their wits end and had tried everything else. In both cases it worked. I still have them use an ointment at bedtime such as Muro 128 or Genteal Gel but the severe pain has stopped.

2. The last technique would be to use the eximer laser to "resurface" the corneal epithelium and soft contact lens wear during the healing. This technique is most often used when the cornea has disease that keeps causing the erosions, the most common of these is corneal epithelial basement membrane disorder.

Keep trying and good luck.

JCH MD

[Miuka]

My eyes hurt after I wake up I the morning. I had worn lenses but hadn't worn it for the last few months. And eyes get red when I wear lenses. What is the cause? PleAse reply.

[John C Hagan III, MD, FACS, FAAO]

1; read the above post and follow the recommendations.
2. see an oph;thalmoloigist   find on at www.aao.org
JCHMD