We have noticed that patients with keratoconus often sleep on their stomach or on their side, with direct contact of the eye on the pillow (« pillow hugging »).
Due to the constrained lateral head position with such a sleeping posture, extended pressure against one or both orbits is typically exerted during sleep. Some patients favour sleeping on the right or the left side. The strong correlation between the side which is more compressed on the pillow/arm/hand at night and the side of the more advanced keratoconus suggests that the sleeping habit may play a significant role in the genesis of keratoconus. In this context, asymmetrical eye rubbing may co-exist, with the eye that is compressed being rubbed more. The direct and prolonged contact of the eyelids against the bed linen may increase the contamination of the ocular surface with irritants and allergens such as dust mites, contributing to increased local pruritis and subsequently increased eye rubbing of the affected side.

TIPS :

• Avoid sleeping face down with the eyes pressed against the pillow.
• If sleeping on one side is preferred, avoiding pillow contact and pressure on the eye /eyelids.
• Firmer pillows may help in the proper positioning of the head during sleep.

Protective eyewear (eg eye shields used after cataract surgery) can also be worn during sleep.

Allergies can make your eyes red, itchy, watery and swollen.
The best thing would be to avoid the triggers of your allergy by limiting your exposure to allergens eg dust mites, pollen

TIPS

• Stay indoors when pollen counts are highest, usually in mid-morning and early evening.
• Use protective eye wear eg spectacles, sunglasses, eye shields
• Do not rinse your eyes with tap water. Sterile saline solutions are a better alternative.
• Do not touch your eyes unnecessarily. If finger-eye contact is necessary, wash your hands before touching your eyes.
• Treat allergies by taking your allergy medications. Eg anti-histamines, mast-cell stabilizers, corticosteroids (in severe cases).
• After removal of contact lenses, if the eyes are uncomfortable, instead of rubbing, use cold packs over the eyes instead.
• Other ways to relieve itch and quell the urge to rub include chilled eye masks, sterile saline eyewash and frequent instillation of artificial tears.
• Use hypoallergenic cosmetics. Eye make-up should be discarded after 3-6 months of use.

Keep your eyes moist by frequently instilling artificial tears. When the eye is dry, symptoms like discomfort, irritation, fatigue and itch tend to trigger eye rubbing.

TIP : Refrigerate your eyedrops. Instilling cold drops can be soothing and bring symptomatic relief.

Blepharitis, which is an inflammation of the eyelid margin due to hyperactivity of the meibomian (oil) glands, is a common source of ocular irritation, and a trigger for eye rubbing. It has to be treated with diligence by practising good lid hygiene.

TIPS :

• Use lukewarm water to regularly clean the eyelids.
• Cleaning solutions specially formulated for the eyelids can be prescribed by your ophthalmologist in more severe cases of blepharitis. This will prevent crusts, scales and oily residue from forming on the lashes and lid margins.
• Warm compresses are an effective home remedy for blepharitis. It helps loosen scales and debris on the lashes and eyelids.

The environment in which you live in should be clean to avoid constant triggers for allergy and hence eye rubbing.

TIPS :

• Use special pillows and pillow covers (with anti-dustmite protection) that keep out allergens.
• Wash bedding frequently in hot water. If your mattress is more than a few years old, consider getting a new one.
• Clean floors with a damp mop. Sweeping tends to stir up dust.
• To prevent mold from growing in your home, keep the humidity under 50%. A dehumidfier may be necessary.
• If your pet is a trigger, keep it outside as much as possible. At the very least, keep it out of your bedroom.

Be aware of what you are doing with your hands. Resist the urge to rub your eyes.
TIPS :

• Wear gloves or mittens when you are finding it hard to keep your fingers from your face. Having something covering your fingers will make the rubbing difficult.
• If you have to touch your face, wash your hands before doing so.

Whether it is a desktop, laptop, tablet or mobile phone, our eyes are often fixated on one screen or another, be it for work, study or play. Digital eye strain or Computer Vision Syndrome has become a public health problem of our generation. Visual fatigue, blurring, headaches and dry eye result, and all these are triggers for eye rubbing. The blue light emitted from these screens can also affect our sleeping pattern, causing more fatigue and dry eye.

TIPS :

• Adjust the colour and brightness of the screen to a comfortable level. The position of the screen should be at a lower level than the eyes. Anti-glare screens can be useful.
• Limit screen time. Finding alternatives such as reading an actual paper book rather than an electronic book can reduce digital eye strain.
• Take the occasional break every now and then by observing the 20/20/20 rule: For every 20 minutes that you are working up close, take a 20 second break to look at something 20 feet further away.

Try to manage your stress level if this is the reason for rubbing your eyes.
TIPS :

• Find something else to do with your hands. You could squeeze a stress ball or rub a smooth rock.
• Try relaxation eye exercises. There are a number of such exercises available.

Sometimes the urge to rub is great, and it takes absolute will-power to avoid rubbing your eyes. If you really need to, here are some less harmful ways of rubbing or touching your eyes :

• Instill sterile saline or artificial tears instead when there is an urge to rub.
• Gently applying a clean, wet facecloth to your eyes to help refresh your eyes or reduce itch.
• Use gel eye-masks and apply it cold to closed eyes.
• Try rubbing around the eyes instead by making circular motions with your index finger and thumb without any pressure on the eye itself. Rotate your hands around the eyes, bearing on the cheekbones and eyebrows.  Many people find that this brings relief to tired eyes, as it gently massages the muscles around the eyes. 
• Try rubbing somewhere else. A good rub of the earlobes feels surprisingly good too!

Do you have your very own technique to avoid eye rubbing? If you do, kindly share some tips with us.