Individuals can sleep with their eyes partially or fully open. This is a recognized medical condition known as nocturnal lagophthalmos. This phenomenon occurs when the eyelids do not completely close during sleep, leaving the eyes exposed to the environment. Although it can be disconcerting, understanding this condition is the first step toward addressing its implications.
Understanding Nocturnal Lagophthalmos
This condition can manifest as eyes that are slightly ajar, or in some cases, completely open, with the eyelids failing to create a complete seal. While the eyes may be open, the brain activity responsible for processing visual information remains inactive during sleep, meaning the individual is not consciously seeing. This incomplete closure can affect one or both eyes. This condition is more common than many people realize, with estimates suggesting it affects between 5% and 20% of the population.
Common Causes of Open-Eyed Sleep
Nocturnal lagophthalmos can stem from structural issues or underlying medical conditions. Anatomical reasons often involve the eyelids themselves, such as eyelids that are naturally short or weak, or conditions like floppy eyelid syndrome where the eyelids are overly loose. Protruding eyeballs, a condition known as exophthalmos, can also prevent full eyelid closure; this is frequently seen in individuals with thyroid disorders like Graves’ disease. Furthermore, scarring from burns, injuries, or complications from eyelid surgeries, such as blepharoplasty, can physically impede the eyelids from closing completely.
Neurological conditions affecting facial nerves or eyelid muscles are another cause. Damage to the facial nerve, specifically the seventh cranial nerve, or weakening of the orbicularis oculi muscle which closes the eyelids, can lead to this issue. Conditions like Bell’s palsy, a temporary facial paralysis, or more severe events such as a stroke, can impair these nerve functions. Tumors that press on facial nerves, or rare neurological conditions like Moebius syndrome, which affects facial and eye movement muscles, also contribute to the inability to close the eyes during sleep. In some instances, nocturnal lagophthalmos can also have a genetic component, indicating it may run in families.
Addressing the Effects of Nocturnal Lagophthalmos
The primary consequence of sleeping with open eyes is chronic ocular surface exposure, leading to eye health issues. Without the protective closure of eyelids, the eyes are vulnerable to dryness, irritation, and redness as the tear film evaporates. This exposure increases the risk of corneal damage, including abrasions, ulcers, and exposure keratopathy, which can cause discomfort and potentially vision impairment. Individuals may also experience symptoms such as blurred vision, sensitivity to light, or a persistent sensation of something being in the eye.
Beyond eye health, nocturnal lagophthalmos can also affect sleep quality. Even if a person is unaware their eyes are open, the discomfort from dryness and irritation can disrupt restful sleep. This can result in reduced sleep duration and more frequent awakenings.
Management approaches primarily focus on protecting and lubricating the eyes. Over-the-counter eye drops and lubricating ointments are commonly used to keep the eye surface moist overnight. Physical protection methods, such as medical tape to gently hold eyelids shut or specialized sleep masks designed to create a moist environment, can also be beneficial. In some cases, small eyelid weights may be used to assist with closure. Addressing the underlying cause of nocturnal lagophthalmos, if identified, is also an important part of a comprehensive treatment plan, and consulting an ophthalmologist or sleep specialist is recommended for an accurate diagnosis and personalized advice.