From the Guidelines
Lagophthalmos is a condition where the eye cannot close completely, leaving part of the eye exposed, and requires immediate attention to prevent corneal damage and vision loss. This condition can lead to deposition of foreign particles in the eye, corneal abrasions, exposure keratitis, and/or corneal ulcerations, as noted in the clinical practice guideline for Bell's palsy 1. Treatment depends on the severity and cause of the condition, but typically includes artificial tears during the day and lubricating ointment at night to prevent corneal damage.
Some key points to consider in managing lagophthalmos include:
- Using preservative-free artificial tears 4-6 times daily, as recommended for patients with dry eye 2
- Applying a thick ointment like Lacrilube or Refresh PM before sleep to provide additional protection
- Taping the eyelid closed at night with paper tape or using moisture chambers (specialized goggles) for extra protection
- Considering temporary measures like external eyelid weights or botulinum toxin injections for moderate to severe cases, as suggested in the management of Bell's palsy 1
- Exploring permanent solutions like gold weight implantation or tarsorrhaphy (partial surgical closure of the eyelids) for severe cases
It is essential to address both symptom management and the underlying cause of lagophthalmos when possible, as the condition can result from various factors, including facial nerve paralysis (Bell's palsy), thyroid eye disease, scarring, or incomplete blinking 1, 2. Regular ophthalmic examination, including age-appropriate vision assessment and slit lamp or alternative portable assessment of the ocular surface, is crucial to maintain normal visual development and protect the ocular surface integrity 2.
From the Research
Definition and Causes of Lagophthalmos
- Lagophthalmos is the incomplete or defective closure of the eyelids, leading to corneal exposure and excessive evaporation of the tear film 3.
- The main causes of lagophthalmos include facial nerve paralysis (paralytic lagophthalmos), trauma or surgery (cicatricial lagophthalmos), and nocturnal lagophthalmos (during sleep) 3.
- Paralytic lagophthalmos can be caused by Bell's palsy, trauma, infections, tumors, and other conditions 3.
Complications and Treatment of Lagophthalmos
- Lagophthalmos can lead to corneal exposure, corneal ulcers, and even loss of vision 4, 5.
- Treatment of lagophthalmos aims to prevent exposure keratitis and reestablish eyelid function, as well as achieve a cosmetically acceptable appearance 3.
- Clinical treatment includes lubricant drops and ointments, while surgical procedures include dynamic and static techniques 3.
- Surgical techniques, such as upper eyelid loading 5 and gold weight implants 6, can be effective in reducing signs and symptoms of exposure keratopathy related to lagophthalmos.
- Staged complex treatment, including lower eyelid surgery, chemodenervation of the upper eyelid levator, and optical reconstructive surgery, may be necessary in some cases 7.