Lagophthalmos is a medical condition characterized by the inability to close the eyelids completely. It can affect one or both eyes and may be present at all times. In some individuals, the inability to close the eyes only occurs during sleep, a variant known as nocturnal lagophthalmos. The exposure of the eye can lead to further complications and can also be an indicator of other underlying health issues.
Symptoms and Underlying Causes
Individuals with lagophthalmos often experience dryness, a gritty feeling as if something is in the eye, and redness. Paradoxically, the eyes may also produce excessive tears, which is the body’s reflex response to severe dryness. This can be accompanied by pain, irritation, and blurred vision, particularly upon waking.
The reasons for this condition fall into two categories: nerve-related problems and structural issues with the eyelids. Damage to the seventh cranial nerve, also called the facial nerve, is a frequent cause, as it controls the muscles responsible for eyelid closure. Conditions like Bell’s palsy, which causes temporary facial paralysis, as well as strokes, tumors like acoustic neuromas, and injuries can all impair this nerve’s function.
Structural problems can also prevent the eyelids from closing properly. Physical trauma to the face or eyelids may result in scarring that restricts movement, a condition known as cicatricial lagophthalmos. Previous eyelid surgeries can sometimes lead to this issue. Conditions that cause the eyes to protrude, such as thyroid eye disease, can make it physically impossible for the eyelids to cover the entire surface of the eye.
Health Risks of Incomplete Eyelid Closure
The primary function of the eyelids is to protect the eye and to spread a thin layer of tears across its surface with every blink. This tear film is important for maintaining a healthy cornea, the clear front part of the eye. When the eyelids do not close completely, this protective barrier is compromised, leaving the cornea exposed to the environment.
Continuous exposure causes the cornea to dry out and become irritated and inflamed, leading to a condition called exposure keratopathy. If this state persists without treatment, it can lead to more significant damage. The dry surface is more susceptible to corneal abrasions, which are scratches on the eye’s surface. These abrasions can become infected, potentially developing into corneal ulcers, which are open sores that can permanently affect vision.
The Diagnosis Process
Diagnosing lagophthalmos involves a thorough examination by an ophthalmologist, including a review of the patient’s medical history and symptoms. The doctor will then perform a physical assessment, observing the patient as they attempt to blink and close their eyes to measure the degree of incomplete closure.
A slit-lamp examination is a key diagnostic tool. This specialized microscope allows the ophthalmologist a magnified view of the eye’s structures, checking the cornea for dryness, abrasions, or other damage. During the exam, the doctor may also observe for Bell’s phenomenon, the upward and outward rotation of the eyeball when a person tries to close their eyes. This reflex is a normal finding but is more apparent when the eyelids do not cover the eye.
Treatment and Management Strategies
Treatment for lagophthalmos is aimed at protecting the eye’s surface and addressing the underlying cause. The initial approach is non-surgical and focuses on keeping the eye lubricated. Frequent use of artificial tears during the day and applying thicker lubricating ointments at night can help maintain moisture. For sleep, some individuals may use moisture chambers, goggles, or tape the eyelids shut to ensure they remain closed.
When non-surgical methods are insufficient, surgical options may be considered. One procedure involves implanting a small weight, typically made of gold or platinum, into the upper eyelid to help it close more completely with gravity. In other cases, a procedure called tarsorrhaphy may be performed. This involves partially suturing the outer corners of the eyelids together to narrow the opening and is often a temporary measure while the underlying cause is treated.