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Lagophthalmos is the inability to close the eyelids completely, which exposes the cornea and can dry or injure the eye. It often follows facial nerve dysfunction, eyelid scarring, or eyelid retraction and may happen only during sleep. People notice burning, foreign body sensation, tearing, light sensitivity, or blurred vision.
read more about lagophthalmos ...Ptosis is a droopy upper eyelid that hangs lower than normal; the eyelid closes but blocks the pupil when open.
On the other hand, lagophthalmos is incomplete eyelid closure, especially during blinking or sleep, which leaves part of the eye uncovered. Both can occur together but point to different problems and treatments.
Ptosis usually involves the eyelid elevator muscle or its tendon. Lagophthalmos more often reflects weakness of eyelid closure from facial nerve palsy, scarring, or eyelid retraction. Identifying which one guides whether treatment focuses on lifting the lid, restoring closure, or both.
Common causes include facial nerve paralysis from Bell's palsy, stroke, tumors, or surgery. Eyelid scarring after trauma, burns, or prior operations can hold the lids open. Thyroid eye disease and eye bulging may prevent complete closure. Sleeping with the eyes partly open, called nocturnal lagophthalmos, exposes the cornea overnight.
Less commonly, congenital eyelid abnormalities, neuromuscular disorders, or reduced corneal sensation contribute to exposure. Any condition that limits blinking or lid coverage increases the risk of dryness, recurrent erosions, and infection.
Typical symptoms include the following:
Incomplete eyelid closure exposes the cornea to drying and trauma, which can progress from mild surface staining to erosions, infectious keratitis, thinning, and perforation. Risk increases with facial paralysis, eyelid scarring, thyroid eye disease, and reduced corneal sensation. Morning discomfort, persistent redness, or recurrent erosions should prompt evaluation.
The outlook is good with early protection and targeted procedures. Many people do well using lubricants, moisture chambers, and tear retention methods. Those with significant exposure benefit from eyelid weights or surgical narrowing, and some regain function after facial nerve recovery or reanimation surgery. Regular follow-up care helps adjust protection as nerve function changes and prevents sight-threatening complications.
References
Cleveland Clinic. Lagophthalmos: Types, Causes & Treatment. https://my.clevelandclinic.org/health/diseases/24413-lagophthalmos
American Academy of Ophthalmology. Lagophthalmos: Evaluation and Treatment. https://www.aao.org/eyenet/article/lagophthalmos-evaluation-treatment
Mayo Clinic. Facial reanimation surgery: Overview and eye risks. https://www.mayoclinic.org/tests-procedures/facial-reanimation-surgery/about/pac-20556545
AAO. Sleeping with Eyes Open. https://www.aao.org/eye-health/tips-prevention/sleeping-with-eyes-open
FDA. Eyelid weight device classification. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=NCB
FDA 510(k). Gold and Platinum Tapered Eyelid Implants. https://www.accessdata.fda.gov/cdrh_docs/pdf20/K203569.pdf
MedlinePlus. Facial paralysis: Home care for eye protection. https://medlineplus.gov/ency/article/003028.htm
EyeWiki. Exposure Keratopathy. https://eyewiki.org/Exposure_Kerato
Diagnosis is clinical. The exam measures the lagophthalmos gap, checks corneal staining with fluorescein dye, and evaluates eyelid position, blinking, and facial nerve function. Corneal sensation and tear film are assessed to estimate exposure risk.
As for the treatment, it focuses on covering and lubricating the eye while addressing the underlying cause. First steps include frequent preservative-free tears, nighttime ointment, moisture chamber goggles or protective taping, and tear duct plugs for tear retention. When protection is inadequate, temporary or permanent surgical narrowing of the eyelid opening can help. For facial paralysis, external eyelid weights or implanted gold or platinum weights assist closure; some patients need facial reanimation surgery. Any infection or ulcer needs urgent treatment to protect vision.
Yes, it can be. Sleeping with the eyes partly open causes overnight dryness and recurrent injury that may lead to exposure keratitis or ulceration. Moisture chambers, protective taping, and ointment reduce risk, and persistent symptoms warrant evaluation.
An ophthalmologist manages surface protection and corneal complications. Oculoplastic surgeons address eyelid position and perform procedures like eyelid weights or surgical narrowing. Neurology or ENT may be involved for facial nerve causes.
Moisture chamber goggles or well-sealed sleep shields that trap humidity work better than standard cloth masks. Fit and seal matter more than brand; your eye doctor can recommend models that work with your eyelids and lashes.