Sleeping with one’s eyes open, medically known as nocturnal lagophthalmos, is a real condition that affects some individuals. It involves the incomplete closure of the eyelids during sleep. This phenomenon can range from a small gap to a significant opening, and while it may seem unusual, it affects approximately 5% of people.
The Truth About Blinking During Sleep
Individuals experiencing nocturnal lagophthalmos do not blink while their eyes are open during sleep. Blinking is a reflexive action that protects and lubricates the eyes, spreading tear fluid to maintain moisture, remove debris, and provide oxygen and nutrients to the eye’s surface.
When eyes remain open during sleep, this protective mechanism is absent. The tear film evaporates rapidly, leaving the eye exposed and vulnerable. Normal sleep involves complete eyelid closure, allowing the eyes to remain moist and protected. The orbicularis oculi and levator palpebrae superioris muscles control eyelid movement, typically relaxing for full closure during sleep.
Why Eyes May Stay Open During Sleep
Nocturnal lagophthalmos can stem from various underlying causes that prevent complete eyelid closure. Neurological conditions, such as Bell’s Palsy or a stroke, can weaken or paralyze the facial nerves and muscles responsible for eyelid movement. Tumors or injuries affecting these nerves can also contribute to the condition.
Physical abnormalities of the eyelids, including floppy eyelid syndrome or scar tissue from previous injuries or surgeries like blepharoplasty, can mechanically hinder full closure. Conditions like thyroid eye disease (Graves’ disease) can cause the eyes to bulge, making it difficult for the eyelids to cover the entire surface. Certain medications, heavy alcohol ingestion, or the use of sedatives and some sleeping pills may also induce or worsen nocturnal lagophthalmos.
Impact of Open-Eye Sleep on Eye Health
When eyes remain open during sleep without the protective action of blinking, they become susceptible to various symptoms and complications. Common symptoms include dry eyes, irritation, redness, a gritty sensation, blurred vision, and increased sensitivity to light.
Prolonged exposure to air leads to tear film evaporation, leaving the cornea vulnerable. This can result in complications such as corneal abrasions (scratches on the eye surface) and infections like conjunctivitis. In severe or chronic cases, the exposed cornea can develop ulcers, potentially leading to vision impairment or loss if left untreated.
Addressing Open-Eye Sleep
Diagnosing nocturnal lagophthalmos typically involves a comprehensive eye examination by a medical professional. The evaluation may include observing eyelid function, assessing the degree of closure during sleep, and examining the corneal surface for signs of exposure or damage. A slit-lamp examination, which uses a microscope and bright light, helps assess the eye’s condition.
Management and treatment options vary depending on the cause and severity of the condition. Non-invasive treatments often include lubricating eye drops, gels, or ointments applied before sleep to maintain moisture. Taping the eyelids shut with medical tape or wearing moisture goggles or a sleep mask can also help ensure complete closure and reduce exposure. For more severe cases, surgical interventions may be considered, such as gold weight implants placed in the upper eyelid to aid closure by gravity, or tarsorrhaphy, a procedure that partially or completely sutures the eyelids together.