Lagophthalmos

Overview

Lagophthalmos is the inability to close the eyelids completely. Normally, blinking and full eyelid closure spread a protective film of tears across the eye and shield it from dust, light, and drying. When the lids cannot meet, part of the clear front surface of the eye (the cornea) stays exposed and can become dry, irritated, and vulnerable to injury.

The condition may affect one or both eyes and can be constant or happen only during sleep, a form called nocturnal lagophthalmos. Lagophthalmos is often a sign of an underlying problem such as facial nerve weakness or eyelid scarring. Protecting the exposed eye surface is important, because long-standing exposure can lead to painful corneal damage and, in severe cases, lasting vision problems.

Symptoms

Symptoms come from the eye surface drying out because the lids do not fully close.

• A gritty, sandy, or foreign-body feeling in the eye
• Redness and irritation
• Burning or stinging
• Excess watering as the eye tries to compensate
• Blurred vision, especially on waking
• A visible gap between the eyelids when the eye is gently closed

Some people notice symptoms mainly in the morning if the eye stays partly open during sleep. Severe pain, sudden vision loss, or a cloudy or white spot on the cornea suggests serious surface damage and needs prompt evaluation.

Causes

Lagophthalmos results from anything that prevents the eyelids from fully closing or weakens the muscle that shuts them. Causes include:

• Facial nerve weakness: conditions such as Bell palsy or nerve injury can paralyze the muscle that closes the eyelid.
• Eyelid scarring or shortening: from burns, trauma, surgery, or skin disease that pulls the lid open.
• Bulging eyes (proptosis): as can occur with thyroid eye disease, pushing the eye forward.
• Reduced muscle tone or deep sleep, leading to nocturnal lagophthalmos.

Identifying the cause guides the best treatment.

Risk Factors

• Facial nerve disorders such as Bell palsy
• Previous eyelid surgery or facial trauma
• Thyroid eye disease causing protruding eyes
• Burns or scarring around the eyes
• Stroke or other neurological conditions
• Deep sedation or unconsciousness

Diagnosis

An eye care professional can usually diagnose lagophthalmos with a focused exam:

• Eyelid closure check: measuring the gap that remains when you gently close your eyes.
• Slit-lamp exam: a magnified look at the cornea, sometimes with a dye that highlights dry or damaged spots.
• Facial nerve assessment: testing the muscles of the face if nerve weakness is suspected.
• Additional tests: thyroid studies or imaging if an underlying cause needs to be confirmed.

Treatment

Treatment has two goals: protect the exposed eye and address the underlying cause.

• Lubrication: frequent artificial tears during the day and thicker ointment or gel at night to keep the surface moist.
• Eye protection: moisture chambers, taping the lid closed at night, or special shields to prevent drying.
• Treating the cause: managing facial nerve conditions, thyroid disease, or scarring.
• Procedures: for persistent cases, options include a small implant to help the lid close or surgery to tighten or reposition the eyelid.

Early, consistent lubrication is key to preventing corneal damage while the underlying problem is treated.

Prevention

• Use lubricating drops and nighttime ointment as directed if you are at risk
• Protect the eye with a shield or taping during sleep if advised
• Treat facial nerve and thyroid eye conditions promptly
• Avoid dry, windy, or dusty environments that worsen drying
• Attend follow-up eye exams to catch surface damage early

When to See a Doctor

See an eye care provider if you notice you cannot fully close one or both eyes, or if your eye feels persistently dry, gritty, or irritated. Seek prompt or emergency care if you have:

• Sudden or worsening eye pain
• A new cloudy or white spot on the cornea
• Sudden change or loss of vision
• Light sensitivity with redness and discharge

These can indicate a corneal ulcer or other serious damage that needs urgent treatment.

Related Topics

Frequently Asked Questions

References

1. American Academy of Ophthalmology. Lagophthalmos and exposure keratopathy.
2. Mayo Clinic. Bell's palsy.
3. MedlinePlus, U.S. National Library of Medicine. Eyelid disorders.
4. National Eye Institute (NEI). Dry eye.