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Lagophthalmos: Causes, symptoms and treatment

If you struggle to close your eyes partially or completely, you may have a condition called lagophthalmos.

Lagophthalmos definition

Lagophthalmos is a condition in which the eyes do not fully close. It can be caused by numerous underlying conditions, from eyelid problems to facial paralysis.

If lagophthalmos only occurs during sleep, it is referred to as nocturnal lagophthalmos.

Although lagophthalmos is not a dangerous condition in itself, it can lead to serious eye problems. It can also be a sign of a serious medical condition that requires special treatment.

Symptoms

The primary symptom of lagophthalmos is the inability to close your eyes. Additional symptoms may include:

  • A sensation of a foreign object in the eye.

  • Increase in tearing.

  • Dry eyes.

  • Blurry vision (due to unstable tear film).

  • Irritation and pain (may be worse in the morning).

Nocturnal lagophthalmos may be more difficult to identify, as it only occurs during sleep. If you experience any of the above symptoms, especially after waking up in the morning or after a nap, contact your eye doctor.

Causes

Lagophthalmos can be caused by damage to the nerves that control the eyelids, whether by an underlying disease or other condition. This can include the following:

  • Stroke.

  • Tumors.

  • Mobius syndrome.

  • Bell’s palsy (facial paralysis).

  • Trauma.

  • Autoimmune diseases such as multiple sclerosis, Guillain-Barre syndrome or temporal arteritis.

Dysfunctional eyelids can also be to blame for lagophthalmos. This may be due to conditions such as:

Underlying causes of lagophthalmos can be mild or severe. In any case, it is important to see an eye doctor for an evaluation to determine what path of treatment should be taken.

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Diagnosis

How is lagophthalmos diagnosed? An eye doctor will discuss any medical problems you’ve had and then perform a physical exam in multiple parts.

Your doctor will first review your medical history. Since lagophthalmos can occur due to an eye infection or injury, it is important to let your eye doctor know if you have experienced either recently. It is also important to tell your doctor if you have an autoimmune disorder or have had any sleeping problems.

After discussing your medical history, your eye doctor will examine your eyelids and eyes. During this exam, you will be asked to look down and close your eyes. If a space exists between your upper and lower eyelids, lagophthalmos is likely present. 

You may also be asked to blink your eyes, and your doctor will record the speed or slowness of your blinks, as well as the force needed to close your eyes — this information is important, as it can indicate an underlying nerve problem.

Your eye doctor will shine a bright light in your eyes to perform a slit lamp exam. This exam helps your doctor identify any damage to the eyes. A fluorescent eye stain test, which helps identify abnormalities in the cornea, may also be conducted.

Treatment

Treatment for lagophthalmos depends on the condition’s origin, severity and duration. Your eye doctor may suggest either a surgical or non-surgical approach.

Non-surgical treatment

Mild cases of lagophthalmos are often treated by targeting its symptoms, such as eye dryness and discomfort. Treatment options may include:

  • Lubricated eye drops (artificial tears) to treat symptoms such as dryness and irritation.

  • Topical ointment (applied to the cornea as directed) to treat cornea dryness.

  • Oral antibiotics to treat infected corneal ulcers associated with lagophthalmos.

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Surgical treatment

Severe cases of lagophthalmos may require surgery. This can include various procedures from special implantations to facial reanimation.

  • Gold weight implantation involves placing special gold weights in the upper eyelid. These weights range from 0.6 to 1.6 g (depending on the right fit for each individual) and aid in keeping the eye closed using simple gravity. 

  • Surgically repositioning the eyelids can improve the condition.

  • A tarsorrhaphy involves placing sutures in the outer corners of the eyelids. This treatment can be temporary if lagophthalmos was caused by a short-term underlying condition. It can also be used as a permanent solution if it was caused by a serious or long-term condition.

  • Facial reanimation may be recommended if lagophthalmos was caused by nerve-related problems (such as facial nerve palsy).

  • Muscle and nerve transfers may also be recommended for lagophthalmos caused by a nerve condition.

How to treat nocturnal lagophthalmos

Treating nocturnal lagophthalmos may be as simple as a fabric sleeping mask for some. For others, a special nocturnal lagophthalmos mask or moisture chamber goggles could be needed to improve the condition. 

Complications

Nocturnal lagophthalmos can have negative effects on sleep. It can also contribute to symptoms of dry eye syndrome — or make existing symptoms worse.

Corneas are exposed in cases of lagophthalmos, as lids are unable to close and protect the eyes. This can result in scratches (corneal abrasion), tears and ulcers. The condition may also lead to exposure keratopathy

Some surgical procedures can also lead to complications. Speak with your eye doctor about the risks and management if your condition requires surgery.

Monitoring lagophthalmos

Lagophthalmos can indicate — or lead to — more complex eye problems. If you experience symptoms of lagophthalmos or nocturnal lagophthalmos, contact your eye doctor for an evaluation. 

Regular eye exams are critical for those who have conditions such as lagophthalmos in order to monitor any progression. Comprehensive eye exams are also important for the general health of your eyes and should be scheduled on an annual basis.

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Lagophthalmos. National Center for Biotechnology Information. February 2021.

Lagophthalmos Evaluation and Treatment. American Academy of Ophthalmology. April 2008. 

Lagophthalmos. Prisma Health. Accessed March 2021.

Nocturnal lagophthalmos: an overview and classification. The Ocular Surface. January 2006.

Better manage nocturnal lagophthalmos for dry eye patients. Optometry Times. February 2020. 

Management of Exposure Keratopathy. EyeNet Magazine, American Academy of Ophthalmology. April 2014.

Nocturnal Lagophthalmos and Sleep Quality in Patients with Dry Eye Disease. Life. July 2020.

Lagophthalmos. Prisma Health. Accessed March 2021.

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