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Why Is My Vision Blurry in the Morning?
Blurry vision in the morning is common and may be caused by either a benign or a medical condition. While the general prevalence of blurry vision in the morning is unknown, the most common reason is dry eye, which is estimated to affect around 8.1% in the United States. Other causes for blurry vision may include changes in the tear film, corneal swelling, uncorrected refractive error, and sleeping in contact lenses. We will discuss both benign and medical reasons for blurred vision in the morning, when you should seek treatment, and how to treat and/or prevent blurred vision.
Quick Overview: Is Morning Blurry Vision Normal?
When you wake up in the morning, you may experience blurry vision. Over seconds or minutes, the blur may resolve or may persist. Temporary blurry vision is most common and usually resolves within minutes. Dry eye/ tear film instability, cornea swelling, incomplete eyelid closure, or changes in the cornea due to overnight lens wear can cause temporarily blurred vision. When the morning blur persists or is recurrent, chronic dry eye, dysfunction of the glands around the eyelid, or pathologic disorders of the cornea may be the cause. Some refractive errors may also cause more blur in the morning. Though rare, an elevated intraocular pressure (IOP), optic nerve or retinal disease, or a transient ischemic event/stroke could result in morning blur.
Dry eye disease, which is the most common reason for blur in the morning, often improves after blinking and washing your face. Blinking recoats the ocular surface with tears, and washing your face cleans the lids and lashes to improve the condition of the meibomian glands.
Pro Tip Box:
If your blurry vision lasts longer than 30–60 minutes, worsens, or occurs with pain, dizziness, or vision loss, you should be evaluated by a doctor immediately.
Normal & Common Causes of Blurry Vision in the Morning
Dry eyes and other ocular surface disorders are the most common causes of blurry vision in the morning.
Dry Eyes (Most Common Cause)
Dry eye disease is the most common cause of blurry morning vision. When you are sleeping, your eyes make fewer tears, you don’t blink while you are sleeping, and tears often evaporate overnight. It is estimated that lagophthalmos, a condition in which someone sleeps with their eyes open, may affect 20% of people. Environmental conditions can dry the bottom half of the cornea when the lids aren’t closed overnight. Those with a history of an eye injury, Bell’s palsy, or a stroke are also at a great risk for developing dry eye while sleeping. Symptoms of dry eye disease include hazy vision, burning, gritty sensation, red eyes, or watery eyes. Age, gender, screen use, and certain types of medications can also be risk factors for developing dry eye.
Tear Film & Lubrication Issues
Poor tear film quality due to overnight dryness is a common cause for blurry vision in the morning. Tear film quality can be improved by blinking and the application of non-preservative artificial tears immediately upon wakening.
Sleep-Induced Corneal Edema
Even in normal, healthy individuals, there is mild swelling of the cornea overnight due to reduced oxygen to the cornea. Corneal edema typically resolves in less than minutes to an hour. Fuchs’ endothelial dystrophy is a common condition that presents in middle age (40s-60s). Due to a breakdown of cells in the endothelial layer, fluid enters the cornea at night, causing it to swell. It is often inherited and is more prevalent in women. It is treated with eye drops to draw the aqueous fluid from the cornea.
Sleeping Environment (Dry Air & Fans)
Your eyes lose moisture overnight, and environmental factors like air conditioning, heaters, and ceiling fans can exacerbate dry eyes. Lid conditions like lagophthalmos or thyroid eye disease can expose the ocular surface to environmental factors overnight. Ceiling fans should be turned off, and vents should be turned away from the bed while sleeping. A sleeping mask can be helpful to protect the cornea from exposure.
Dehydration
Systemic dehydration, which can occur after alcohol use, can result in blurry vision in the morning. Dehydration causes the body to produce less tears, which may cause blurry vision and irritated eyes.
Allergies
Allergies and allergy medications can worsen dry eyes. It is possible to have ocular allergies without having systemic allergies, and symptoms/signs may include morning mucus, itching, and eye rubbing. Allergy medications block histamine production and reduce tear production by affecting both the tear glands and nerves. They also dry out mucous membranes, which leads to dryness and temporary blur.
Contact Lens-Related Causes
Sleeping in contact lenses is never a good idea. Contact lenses further reduce the delivery of oxygen and can result in warpage of the cornea, unhealthy blood vessel growth, and painful corneal ulcers. Additional habits, including poor hygiene, not changing your lens according to the wear schedule, and protein buildup because of poor cleaning technique, can lead to blurry vision in the morning and throughout the day.
Pressure on the Eyes During Sleep
Sleeping face down may cause the pillow to put pressure on your cornea, changing the shape of the cornea and leading to temporarily blurred vision.
Refractive Errors
Mild, uncorrected refractive errors like hyperopia and astigmatism may lead to blurry vision in the morning because of reduced tear production and an uneven tear film. Newly onset presbyopia in the early 40s results in reduced accommodation and blurry near vision. The near blur may seem more pronounced in the morning.
Medical Conditions That Can Cause Blurry Vision in the Morning
Chronic medical conditions like dry eye disease, blood sugar fluctuations due to diabetes, cataracts, and other systemic conditions may cause blurry vision in the morning.
Chronic Dry Eye Disease
Chronic dry eye disease can result in both transient and persistent acute blurry vision in one or both eyes, which may be caused by either insufficient tear production or rapid evaporation of the tears from the ocular surface. Depending on the type of dry eye or the gland/lid inflammation, the symptoms may persist beyond the morning. Dry eye disease requires medical treatment, including lid hygiene, preservative-free artificial tears, and/or other prescription ophthalmic medications. The symptoms and signs are likely to persist, but treatment is aimed at improvement.
Diabetes & Blood Sugar Fluctuations
Fluctuations in blood sugar because of diabetes can cause temporary lens swelling and blurry vision, which may be worse after eating. Though rare, it may also cause visual fluctuations after waking up. Blurry vision from diabetic retinopathy may occur gradually and is caused by bleeding, swelling, or ischemia in the retina.
Cataracts
A cataract is a gradual clouding of the eye’s natural lens, which reduces the lens’s clarity and prevents light from focusing on the retina. Cataracts may result in vision that is worse in low light and cause more glare and a halo around lights.
Post-Surgical Causes
Blurry vision in the morning after cataract or refractive surgery is expected. Both surgeries result in dry eye, which improves over weeks to months. If you are experiencing blurry vision after a surgery, you should contact your doctor, who can advise if what you are experiencing is the normal recovery process vs. a surgical complication.
Eye Infections or Inflammation
The cornea is the eye’s primary focusing surface, so any infection or inflammation can result in blurry vision. Because the corneal swells overnight, the vision may appear worse in the morning. Conjunctivitis and blepharitis may result in blurry vision due to the excessive production of discharge, eyelid and eyelash crusting, or swelling of the anterior structures of the eye.
Neurological or Systemic Causes
Blurry vision in the morning, which presents with dizziness or weakness, could be a sign of a serious neurological condition like a stroke or TIA. Both conditions are emergencies and require urgent medical care. Chronic hypertension and/or the medications used to treat it may cause blurry vision. Sleep apnea is often treated with a CPAP machine, which keeps the airway open during sleep to prevent breathing interruptions, but may blow air into the eyes, resulting in red, irritated, dry eyes.
Medication Side Effects
Blurred vision is a known side effect of many types of medications, including antihistamines, antidepressants, blood pressure medications, and sleep aids. These medications reduced tear film production, leading to dry eye and blurry vision.
When Blurry Vision in the Morning Is NOT Normal?
Blurry vision that lasts hours, only occurs in one eye, presents with eye pain and a severe headache, flashes, floaters, or a curtain, or with the neurological signs of a stroke, may be caused by an emergency condition. Blinking does not improve the blur in abnormal causes of blurry vision.
When to Seek Medical Attention? Red Flags
Blurry vision in the morning and in one eye can be a symptom of a serious medical emergency, which necessitates a visit to see a physician. Sudden vision loss or blurring in combination with flashes, floaters, or a curtain-like shadow may indicate retinal detachment, which requires urgent treatment. Eye pain with blurry vision could be one of several different eye problems, including optic neuritis, a corneal ulcer, or acute glaucoma. If blurry vision presents with a neurological symptom like facial droop, weakness, or difficulty speaking, a stroke may have occurred, and one should go to the emergency room.
How Doctors Diagnose Morning Blurry Vision?
Every comprehensive eye exam will begin with a complete systemic and ocular history, including medications, chronic diseases, and other questions about when, how long, and other symptoms that may present with blurry morning vision. Visual acuity testing is an assessment of your ability to read the Snellen chart at 20 feet, and a refraction will determine whether glasses will improve your blurry vision. A slit lamp exam is used by the doctor to assess the front of the eye, including the lens. An eye care provider may use several testing methods to diagnose dry eye, including tear break-up time, Schimer’s, and fluorescein may be used to assess the health of the cells on the cornea and conjunctiva. If the doctor suspects a chronic condition to be the cause, they may order a blood sugar test (A1C) or other testing when indicated.
How to Fix Blurry Vision in the Morning?
Morning blur can be improved with treatment, lifestyle changes, and improved hygiene.
Remedies for Dry Eyes
First-line treatments for dry eye include preservative-free artificial tears, warm compresses, and lid hygiene. Dry eye is considered a chronic disease, and treatments should be performed consistently and proactively. Discuss the options of artificial tears with your eye care provider; they may recommend a brand based on their clinical assessment of your dry eye. A device like a Bruder mask is often preferable over warm compresses because they stay warm longer and warm the oil inside the meibomian glands to improve their function. Lid scrubs should be used at night after washing your face to keep your lids and lashes clear of bacteria.
Lifestyle & Sleep Adjustments
Several lifestyle changes may improve your blurry vision in the morning. The use of a humidifier can add moisture to the air, particularly during the winter months. Turn off ceiling fans and aim all heating/AC vents away from your face to reduce overnight dryness, or wear an eye mask while sleeping.
Contact Lens Hygiene
Practice good contact lens hygiene. Replace your lenses on schedule, clean and store them according to the care instructions on the lens solution packaging. Never sleep in your contact lenses. Contact lens materials reduce oxygen to the eye and can result in corneal ulcers, scarring, and permanent vision loss. Consider switching to a daily disposable lens to improve lens comfort and dryness. Daily contact lenses are the healthiest option for the eye because they are always clean, fresh, and reduce the risk of red eyes, dry eyes, and other eye infections.
Medical Treatments
The treatment for blurry vision depends on the cause. Your eye doctor can recommend the best prescription eye drop depending on the cause of your dry eye. Restasis, Xiidra, or a short-term course of steroids may be used to control the dryness. Not all drops will work for everyone, so you may need to try several or use them in combination for the best relief. Oral medications, including doxycycline or tetracycline, may be used to treat blepharitis or ocular rosacea. If the reason for the blurry vision is a medical condition like diabetes or allergies, long-term chronic management is needed. Your PCP may need to alter or change your medications for better control.
Prevention Tips for Blurry Vision in the Morning
You may be able to prevent or improve blurry vision in the morning with proper eye care and treatment. Annual eye exams, a healthy diet rich in omega-3’s, chronic disease management, and healthy sleep patterns are key to systemic and ocular health. Smoking cessation and eye protection against UV rays from the sun are also important for long-term health. Ocular conditions like dry eye are chronic conditions, and those who suffer should be proactive in using artificial tears and ocular surface regiments. Taking frequent breaks from digital devices, spending more time outdoors, and reducing your overall screen time can improve your dry eye symptoms. Opt for wearing classes over contact lenses when possible, as contact lens wear alters the tear film layer and results in dry eye.
When to Call the Doctor?
You should call your doctor if the onset of your blurry vision is sudden or seems to worsen. If the blurry vision occurs daily, is present in only one eye, and does not improve with time or blinking, a physician should be consulted. Most importantly, if the blurry vision occurs in combination with neurological symptoms like slurred speech, double vision, weakness of the face, arm, or leg, or facial droop, you should go to the ER.
FAQs About Blurry Vision in the Morning
Yes, it is both common and normal to have temporarily blurry vision right after waking up. Blinking will often clear your vision within a few seconds to minutes.
Your vision clears after blinking because your eyelids push the tears across the surface of the eye, restoring the ocular surface and creating a clear medium. An uneven tear film causes light to scatter. The glands around your eyelids also produce an oil with each blink, which helps to balance the tear film and reduce the evaporation of tears from the eye.
Blurry vision that lasts for minutes to an hour may be normal. Normal causes for blurry vision typically improve with blinking, the use of artificial tears, affect both eyes, and remain stable or improve with time. If the blurry vision persists, occurs in only one eye, or you experience symptoms of eye pain, redness, headaches, or nausea, you should see a doctor. If the blur worsens or doesn’t improve after blinking, washing your face, or using drops, you should schedule an exam.
Yes, dry eyes can cause blurry vision only in the morning. Overhead fans, incomplete lid closure while sleeping, overnight lens wear, and normal overnight changes in the cornea can exacerbate dry eye.
Using artificial tears in the morning and a thicker ointment or gel drop overnight can improve blurred vision in the morning. Sleeping with an eye mask and turning off overhead fans may also be beneficial.
Though diabetes can cause blurry vision, blurry vision in the morning is not typically a sign of diabetes. Diabetes often causes changes in vision with blood sugar fluctuations or diabetic retinopathy, which results from chronically high blood sugar levels.
