Lagophthalmos: Causes, Symptoms, and Treatments

If you have trouble closing your eyes all the way when you blink or sleep, you may have a condition called lagophthalmos.

“Lagos” is the Greek word for “hare,” an animal some believed slept with its eyes open. Your eyes might be dry and irritated. They’re also exposed to dirt and other things that could damage them. Anyone can get it, but the condition tends to affect adults more. That’s because we make fewer tears as we age. Here’s what you need to know.

Causes

One of the most common causes of lagophthalmos is Bell’s palsy. That’s a sudden and mostly temporary weakness in the muscles on one side of your face. Others include:

  • Trauma
  • Infection
  • Tumors
  • Scarring from surgery, injury, or disease
  • Your doctor taking off too much skin during eyelid surgery
  • Side effects of medication for sleep and pain during surgery (anesthesia)
  • Eye bulge, which prevents the eye from fully closing

Symptoms

Symptoms of lagophthalmos include:

If you have lagophthalmos when you sleep, your symptoms may be worse in the morning and get better during the day. Some people who sleep with their eyes partially open won’t have any symptoms. That’s because their eyes naturally roll back to protect the cornea.

Diagnosis

Asking a friend or family member is one quick way to check if you close your eyes when you sleep. If you’re OK with it, have them take a picture of your eyes.

You’ll still need to see an ophthalmologist (eye doctor) to be sure it’s lagophthalmos. They’ll start by watching you blink to see if you close your eyes all the way. They’ll also ask about your medical history and any symptoms you’ve had.

Another way your doctor may check for this condition is with light. First, you’ll close your eyes and relax like you’re about to fall asleep. Then the doctor will put a light against your eyelid to see if it shines through your upper and lower lids.

They might also use a special microscope and light called a slit lamp, which gives a 3D view of your eyes. The doctor will squeeze a few drops of dye into your eyes. That’ll show whether they’re fully closed when you blink. They’ll also look for any signs of eye damage.

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Treatment

The doctor will help you figure out the best way to manage your lagophthalmos. Treatment may include:

Avoiding dry air. Dry air can make this condition worse, so try to stay away from air vents and fans. Use a humidifier to put more moisture into the air.

Eyedrops. Drops and ointments moisten your eyes and protect the cornea, but may blur your vision.

Eye protection. Eye patches, masks, and special tape lock in moisture and keep your eyes comfortable at night, especially when you use them with drops or ointments.

Eyelid weights. These help people who have trouble closing their eyes because of palsy. The weights are taped on.

Surgery. For severe cases, your doctor might suggest surgery to lift and tighten the eyes, or implants that help to close your eyelid. They’ll look at your age, health, and how serious your condition is before deciding the best treatment. They will likely refer you to an oculoplastic surgeon, an ophthalmologist who specializes in eyelid surgery.

WebMD Medical Reference Reviewed by Whitney Seltman on July 21, 2020

Sources

SOURCES:

American Academy of Ophthalmology: “Sleeping with Eyes Open,” “Can I be tested whether I close my eyes when I sleep?” “Exposure Keratopathy.”

International Journal of Gerontology: “Nocturnal Lagophthalmos.”

American International Medical University: “Lagophthalmos: Symptoms, Causes, Diagnosis and Management.”

Eye Contact Lens: “A novel lid seal evaluation: the Korb-Blackie light test.”

Seminars in Ophthalmology: “Lagophthalmos.”

Prisma Health: “Lagophthalmos.”

Mayo Clinic: “Bell’s palsy,” “Cornea transplant.”

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