Lagophthalmos

What is lagophthalmos?

Lagophthalmos (pronounced “la-guhp-thal-mowz”) is a medical term for when you can’t close your eyelids completely. It can happen in one or both eyes.

Lagophthalmos can happen on its own or be related to another type of medical disorder like ptosis (sagging eyelids). Lagophthalmos may also be a complication of surgical treatments like blepharoplasty or ptosis repair (eyelid surgery).

Mild lagophthalmos doesn’t usually cause many problems, but it can lead to more serious issues. If you can’t close your eyes, your cornea is exposed to wind, dirt and other irritations. In some cases, this exposure can lead to scarring or vision loss.

Types of lagophthalmos

There are different forms of lagophthalmos, including nocturnal, paralytic, mechanical and cicatricial.

Nocturnal lagophthalmos

The word “lagophthalmos” means “hare-like eyes.” Hares (like rabbits or bunnies) were once thought to sleep with their eyes open. Although scientists now think that most hares sleep with their eyes closed, about 20% of people sleep with their eyes open. In nocturnal (or nighttime) lagophthalmos, your eyes close normally when you’re awake but not when you’re asleep.

Paralytic lagophthalmos

Your eyes may not close completely if you’ve lost function (paralysis) in your facial nerve. You have facial nerves on both sides of your face.

Mechanical lagophthalmos

Sometimes, structural problems or trauma lead to mechanical lagophthalmos rather than nerve problems. Cicatricial lagophthalmos is one type of mechanical lagophthalmos.

What are the signs and symptoms of lagophthalmos?

Although the major sign of lagophthalmos is that your eyelids don’t close correctly, there are also other signs and symptoms, including:

• Eyes that water or are dry.
• Feeling like something is stuck in your eye, or you have burning or pain in your eye.
• Blurred vision.
• Red eyes.
• Photophobia (sensitivity to light).
• A sore on the cornea of your eye (corneal ulcer).

What causes lagophthalmos?

Lagophthalmos can happen for several reasons. However, it’s not contagious. You can’t give it to someone else, and you can’t catch it from anyone.

There are two main reasons that you can develop lagophthalmos: damage to your facial nerve or damage to your eyelids.

Lagophthalmos due to nerve damage

Injury to your facial nerve can happen due to:

• Eye injuries from accidents or cuts.
• Bell’s palsy.
• Stroke.
• Tumors, including acoustic neuromas.
• Autoimmune disorders, like Guillain-Barré syndrome.
• Moebius syndrome.
• Infections.
• Toxins.

Lagophthalmos due to eyelid damage

Eyelids can be damaged or scarred in various ways, including:

• Lax eyelid syndrome (LES), such as floppy eyelid syndrome (FES). Lax eyelids are lids that can be expanded or stretched out. They move inside out easily and sometimes spontaneously. Floppy eyelid syndrome mainly affects men and people assigned male at birth who have overweight or obesity (BMI > 25).
• Medical conditions, like Stevens-Johnson syndrome, which can blister skin.
• Chemical burns.
• Sun damage to your skin.
• Surgery on your eyelids (ptosis repair or blepharoplasty).

How is lagophthalmos diagnosed?

An eye care provider will diagnose lagophthalmos through a series of tests. They’ll likely:

• Ask you questions about health history.
• Ask you to close your eyes.
• Observe how forcefully you close your eyes.
• Measure your eyelids.
• Count how often you blink and notice how completely your eyes close during a blink.

How is lagophthalmos treated?

Treatment of lagophthalmos will depend on the cause. Your healthcare provider will want to treat any underlying causes, such as infections, tumors or skin conditions.

Therapy for lagophthalmos may include surgical or nonsurgical interventions.

Nonsurgical treatments for lagophthalmos

• Eye drops, like artificial tears.
• Ointment used at night to provide additional moisture.
• Tape to keep lids closed at night or patching to keep moisture in.
• Special glasses (moisture goggles) that help keep eyes moist.
• Weights you can tape to your eyelids.

Surgical treatments for lagophthalmos

• Tarsorrhaphy: A surgical procedure that involves sewing your eye partially or completely shut. This can be a temporary or permanent procedure.
• Implanting gold or platinum weights in your upper eyelids: This procedure puts small weights into your eyelids and then relies on gravity to close your eyes if you have paralytic lagophthalmos.
• Upper eyelid surgeries: These include surgeries on the retractor muscles in the upper lid and skin grafts.
• Lower eyelid surgeries: These include procedures to tighten lower lids that are “floppy” and skin grafts to elevate your lid.
• Facial surgeries: There are many procedures that may be used to lift your face to deal with lagophthalmos due to facial paralysis. Some of these are nerve grafts and moving soft tissue.

Complications/side effects of treating lagophthalmos

Possible complications following lagophthalmos treatment include:

• Scarring.
• Infection.
• Entropion (when your eyelashes turn inward).
• Drooping eyelids.
• Graft site issues.

How can I manage symptoms of lagophthalmos?

There are some things you can do for yourself in terms of keeping your eyes lubricated. These may include using eye drops and taping your lids closed at night.

If you have facial paralysis, you may need help with other functions like eating or speaking.

How can I reduce my risk of lagophthalmos?

You can’t prevent lagophthalmos, but you can take steps to protect your eyes, including:

• Wearing safety equipment that covers your eyes when you work or play contact sports.
• Wearing sunglasses to protect your eyes in bright sun.
• Avoid touching your eyes unnecessarily.
• Washing your hands before touching your eyes.

In addition, if you’re considering ptosis repair or blepharoplasty, schedule a consultation with an oculoplastic surgeon. Oculoplastic surgeons are ophthalmologists who specialize in reconstructive surgery around the eyes.

What can I expect if I have lagophthalmos?

The outlook for lagophthalmos is generally good, especially for mild cases. Bell’s palsy cases usually resolve by themselves.

However, treatment is important for more advanced cases.

When should I see my healthcare provider about lagophthalmos?

Contact a healthcare provider if you have symptoms that concern you, like dry eyes, watery eyes or a continual feeling that you have something in your eye. Always contact a provider if you have any change in vision.

If you’ve been diagnosed with lagophthalmos and you’re treating it as directed, contact your provider if symptoms aren’t improving or are getting worse.

A note from Cleveland Clinic

You may not even realize your top and bottom eyelids don’t close perfectly until it affects your eyes. Often, this uneven closing (lagophthalmos) is a result of some type of facial paralysis, like Bell’s palsy. Make sure you contact a healthcare provider if you have any type of vision problem or uncomfortable feeling in your eye or eyes that won’t go away.