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Lagophthalmos

Lagophthalmos is an annoying disorder of the eye in which the eye doesn’t fully close properly, either during the day when blinking, or at night when sleeping.

The word lagophthalmos comes from the two Greek words “lago” meaning hare and “ophthalmos” meaning eye –  since a hare sleeps at night with its eyes open (which is not a well known fact).

The condition of lagophthalmos is not only unpleasant for the sufferer but can lead to quite a few problems:

•    Eyelids need to close to let tears flush away any dust or grime

•    The eye may dry out – if it does then that in itself can cause further complications including some nasty things like ulceration of the cornea

•    At night – when the condition may go under the name “nocturnal lagophthalmos” – pillows and bed sheets can stimulate abrasion of the eye surface, again leading to further complications

•    By being continually open the eyes are more susceptible to infection

•    Excessive and continual light causes the eyes to water

Diagnosing Lagophthalmos is not easy!

When a patient attends the clinic of an optometrist, symptoms of gritty feelings in the eyes, excessive watering during the day and dryness in the morning that takes up to half an hour to clear up, are common to most eye disorders – so it is going to be difficult to isolate!

A condition of lagophthalmos may go completely unnoticed during an examination – simply because during an examination THE EYES ARE OPEN!

It should be pointed out here of course that a fully qualified optometrist or ophthalmologist will know the procedures to adopt to lead to a successful diagnosis:

During daytime the patient will be asked to relax and close their eyes for a few minutes – the condition may readily present itself.

The question of nocturnal lagophthalmos requires the optical practitioner to be somewhat devious, since many patients suffering from the condition will close their eyes fully initially.  The patient should be asked to lie down for a while on the pretext of say measuring pulse when relaxed – it’s best not to mention eyes as this will only encourage the patient to react maybe and inadvertently forcibly close the eyes up fully.

Measurements of frequency of blinking can also be taken to provide more information for the diagnosis – normally a person blinks every 8 or so seconds – if the patient blinks every 2 or 3 seconds, then something is amiss.  Whilst examining the eyes using a slit lamp biomicroscope the practitioner will ask the patient to blinking naturally for a while, often incomplete blink patterns emerge which is a sign of lagophthalmos.

Why does it occur?

There are a whole lot of probable causes:

•    Malfunction of facial nerves near the eye

•    A patient may be suffering from Bell’s palsy, which is a paralysis of muscles on one side of the face also affecting the eyes, thought to be brought about by an infection or from exposure to the herpes simplex virus, or perhaps an auto-immune response

•    Thyroid disease, Graves’ disease, diabetes – all can affect dryness of the eyes

•    Hereditary factors – family history needs to be explored at the initial consultation

•    Previous surgery – especially a blepharoplasty procedure – which modifies the eyelids and is very often now carried out using laser surgery.

On the last point it may be that the increased use of laser surgery during blepharoplasty, mainly because of simplicity and the improved outcomes, is responsible in a way for the increase in instances of lagophthalmos.

It is really important that patients who have a blepharoplasty are followed up for no other reason than to check out for any symptoms of lagophthalmos.

Conventional treatments

Prevention is better than cure they say, so before any eyelid surgery is contemplated, either for medical or cosmetic reasons, an ophthalmologist should be consulted who can ascertain the likelihood of some degree of lagophthalmos developing.  Referral to an oculoplastic eye surgeon is paramount for any lid surgery.

Eye drops can be used up to four times during the day to keep the eyes moist, and maybe that’s all the treatment that may be required. In addition to eye drops a topical ointment would be used prior to sleep.

A conventional surgical procedure called a “tarsorrhaphy” in which the eyelids are partially sewn together is an option. Occasionally the result is not attractive (but nevertheless effective), however the procedure is reversible

Innovative treatments

Some of the treatments being employed today are indeed innovative!

Taping the eyelids together provides a quick and easy remedy. Surgical tape is used since it is readily removed.

The use of small gold weights implanted in the upper eyelid is very effective in closing the upper lid down. Only a very tiny piece is sufficient to hold down the eyelid using gravity. If the outcome doesn’t look too good, then the implants are easily removed.

Eye goggles that hold in moisture at night are not only used to treat nocturnal lagophthalmos but interestingly do have a place during the day – when outdoors resting for example, or listening to music and importantly when working on dirty and dusty tasks!

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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