Eyelid exposure, medically known as lagophthalmos, is the inability to completely close the eyelids, either during blinking or sleep. This incomplete closure leaves the eye’s surface unprotected, leading to excessive tear evaporation and persistent dryness. Addressing lagophthalmos is important to restore the eye’s natural protective barrier and prevent complications like infection or vision loss.
Causes and Recognition of Eyelid Exposure
Lagophthalmos often stems from problems with the facial nerve or structural issues affecting the eyelid itself. Paralytic lagophthalmos, for instance, occurs when the seventh cranial nerve, which controls the orbicularis oculi muscle responsible for eyelid closure, is damaged. Common causes of this nerve damage include Bell’s palsy, stroke, tumors, or physical trauma. Structural causes can also prevent full closure, such as scarring from burns or infections, or complications following cosmetic procedures like blepharoplasty.
Thyroid eye disease can cause eyelid retraction, which pulls the eyelids back and mimics lagophthalmos. Nocturnal lagophthalmos is a specific type that occurs only during sleep, often due to age-related laxity or a decrease in orbital fatty tissue. The condition is recognized by symptoms similar to severe dry eye, including burning, redness, and the constant feeling of a foreign object in the eye. A primary sign, often noticed upon waking, is eye pain or blurred vision, especially in the morning.
Non-Surgical Management and Symptom Relief
Protecting the eye surface and supplementing the tear film are the immediate steps in managing eyelid exposure. Frequent application of artificial tears, specifically non-preserved formulations, helps to maintain lubrication throughout the day. The frequency of use can be as often as every few hours, depending on the degree of exposure and dryness. For nighttime protection, thicker lubricating gels or ointments are often recommended because they offer extended coverage while the eye is closed. Because these thicker products can cause temporary blurred vision, they are best suited for use right before sleep.
If ointments are insufficient, patients can use external aids like specialized moisture-chamber goggles or eye shields. A simple and effective technique for temporary relief is gentle eyelid taping, which physically holds the eyelids closed during sleep. Medical-grade tape is used to secure the upper eyelid down to the cheekbone, preventing nocturnal exposure. The use of a cool mist humidifier in the bedroom can also reduce tear film evaporation, providing a more moisture-rich environment for the eyes overnight.
Medical Procedures to Restore Eyelid Closure
When conservative measures fail to protect the cornea or the lagophthalmos is severe and chronic, medical and surgical procedures become necessary. One common surgical approach involves placing small, thin weights, typically made of gold or platinum, into the upper eyelid. This upper eyelid loading procedure uses gravity to help the eyelid close more effectively when the patient relaxes the muscle. Before implantation, a proper weight is selected by temporarily adhering different weights to the outer eyelid to test for complete closure without causing excessive drooping. The implant is secured within a pocket between the orbicularis oculi muscle and the tarsal plate.
Another procedure is tarsorrhaphy, which involves surgically fusing the upper and lower eyelids partially together, often at the outer corner. This narrows the opening of the eye, reducing the exposed surface area and protecting the cornea from drying out. Tarsorrhaphy can be temporary, using sutures that are later removed, or permanent, depending on the prognosis for facial nerve recovery.
For specific cases, such as eyelid retraction related to conditions like thyroid eye disease, botulinum toxin (Botox) injections can be used. The toxin is injected into the levator palpebrae superioris muscle to induce a temporary, controlled drooping (ptosis) of the upper eyelid.