7 Best Lagophthalmos Treatments - What Is It and What Causes It?
What is Lagophthalmos? Lagophthalmos Definition
Lagophthalmos is the incomplete closure of the eyelids. It is well known that tight eyelids, full eyelid closure and a proper blink are essential for the health of the eyes. When the eyelids are unable to fully close, it will be difficult for the eyes to maintain a stable, healthy tear film and ocular surface. Often, those with this condition find that their eyes easily become very dry and uncomfortable.
In addition to dry eye disease in general, chronic lagophthalmos may lead to excessive corneal exposure and eventually exposure keratopathy. Those who do not address this issue may find themselves in a situation where corneal ulceration and even perforation can occur.
What Causes Lagophthalmos? Types of Lagophthalmos
There are quite a few possible causes for lagophthalmos. First of all, you can experience this condition due to incomplete eyelid closure during sleep, although this condition can also result from paralysis and eyelid scarring due to surgery or trauma.
The facial nerve innervates both the orbicularis oculi, which is the muscle surrounding the eye which closes the eyelids, and the frontalis muscle of the forehead. This muscle is responsible for lifting the eyebrows. Loss of function in the facial nerve will inhibit both the natural blink reflex and the ability of the lacrimal gland to pump tears onto the surface of the eyes. Facial nerve weakness is a major cause of lagophthalmos, and it can result from any of the following:
Bell’s palsy and other idiopathic conditions
Strokes or Cerebrovascular Accidents
Metabolic issues (diabetes, hypertension)
Bell’s Palsy is responsible for roughly 80% of facial nerve paralysis in the United States. There is no known cause for this condition, although it is thought to be related to a viral infection. This acute, unilateral facial nerve paralysis occurs spontaneously and resolves on its own over time. Fortunately, about 84% of people suffering from Bell’s Palsy will regain full facial nerve functioning after the condition has resolved itself.
Those with nocturnal lagophthalmos may or may not realize that they sleep with their eyelids slightly open. This is often due to an issue with the muscles or nerves of the eyelids and face, and it can be quite bothersome when trying to get a good night’s rest. Patients who are suffering from nocturnal lagophthalmos may experience insomnia and excessive dry eye symptoms (burning, irritation, redness) upon awakening.
Those with floppy eyelid syndrome (FES) are more susceptible to this condition because their eyelids have excess laxity that makes it difficult for them to maintain tightness against the eyeball. When pulled on, the eyelids should snap back into place quickly. For those with FES, their eyelids may stretch an incredible amount and may take time to go back into place. It’s suggested that FES may be associated with obstructive sleep apnea and even certain sleeping positions that pull on the eyelids.
Chemical or thermal burns as well as mechanical trauma can cause scarring of the eyelids and lead to lagophthalmos. Other conditions may include Stevens-Johnson Syndrome and ocular cicatricial pemphigoid, which can both lead to scarring of the eyelid tissue.
Care should be taken during ptosis surgery as well, as occasionally too much tissue can be removed and cause the eyelids to improperly close.
When treating lagophthalmos, the main purpose is to prevent exposure keratopathy and more severe conditions that can result from this. Reestablishing eyelid functioning is also a goal of treatment, although sometimes this is not always feasible depending on the cause of the condition.
It is important that you first have a proper diagnosis before considering treatment, and the right doctor can help diagnose the cause of your condition as well as provide you with a treatment plan that makes sense for the cause of your lagophthalmos. Below, you’ll find some of the most common treatments.
If you’re suffering from this condition, the first treatment your doctor will prescribe will be artificial tears and ointments. We recommend using preservative free artificial tears throughout the day and then using an ointment at night. The ointment will help coat and protect the cornea from exposure during the night, and occasionally ointments may be needed during the day as well.
2. Treat MGD and Blepharitis
If you’re suffering from lagophthalmos and dry eyes because of it, it’s also likely you have some form of blepharitis or meibomian gland dysfunction. It’s important to treat these common conditions with eyelid hygiene (and sometimes other measures) in order for the eyes to stay properly hydrated and heal more easily. For eyelid hygiene, we recommend hypochlorous acid spraybecause it’s well tolerated by most, it’s a natural component of your body’s ability to heal, and it’s simple to use. Simply spray the eyelids and lashes with the solution after you’ve washed your face, rub it into your closed eyelids, and let it dry. Use any ocular lubricants after eyelid cleansing.
Not just any sleep mask will do here! It’s recommended to use a medical grade, silicone sleep mask that slightly vaults over the eyes to create a seal. This seal effectively creates a more moisture-rich environment during sleep, helping the ocular surface maintain moisture. Physically taping your eyelids shut is another option, although medical masks used correctly can usually provide more relief and less adverse side effects.
4. Avoiding Fans and Air Vents
Although this tip might seem simple, it’s something that not everyone thinks about. When your eyes are slightly open at night, the bottom part of your eyeball (and especially your cornea) is exposed to the outside air. This is going to greatly increase the dryness you feel and may even cause dry patches on the front surface of your eyes. To avoid some of this issue, make sure you either turn off all fans or point them away from you. Ceiling fans are the biggest offenders for dry eye! You may want to also pay attention to where your air vents are pointing, and ensure that you point them away from your face during sleep.
A tarsorrhaphy can be performed when the front surface of the eyes need a little extra healing. This procedure usually involves suturing together the outer ⅓ of the eyelids to ensure that the front of the eyeball is more adequately covered by the eyelid. The surgeon will usually leave an opening large enough for you to see through, and this is helpful for not only vision but also for applying medications and evaluating how the cornea is doing. A tarsorrhaphy is reversible and can be a great option for those whose condition may likely resolve on its own.
6. Implantation of Gold Weights
For those who suffer from paralytic lagophthalmos, the implantation of gold weights in the eyelids can be useful. An interesting concept, this therapy makes use of gravity and small weights to weigh the eyelids shut. Gold is used because it is an incredibly safe substance that is inert and will not react with your body. It’s also harder to see underneath the thin eyelid skin, which is best for cosmetic purposes. These weights range from 0.6-1.6 grams, and the ideal weight will allow both sufficient closure and opening of the eyelids. Platinum is also an option for material if you happen to have an allergy to gold.
7. Eyelid surgery
Depending on your condition, eyelid surgery may be the best option to relieve lagophthalmos. If you suffer from lagophthalmos due to thyroid eye disease, a recession surgery of the upper eyelid muscles may be beneficial. Those who have this condition post-blepharoplasty or scarring may require a graft to fully close the eyelids. If lower eyelid laxity is the issue, eyelid tightening procedures can be performed to more adequately place the eyelids against the eyeball. Occasionally, more advanced procedures may be necessary in those who are really suffering and continue to have ocular pathology secondary to their lagophthalmos.
If you think you may be suffering from lagophthalmos, speak with your eye doctor. They will take the time to properly check your condition and can give you an idea of the best treatment options for you.