From the Guidelines
The patient with 3mm lagophthalmos requires immediate management to prevent corneal exposure and damage, and I recommend aggressive lubrication with preservative-free artificial tears every 1-2 hours during the day and a thicker lubricating ointment at night, as suggested by the most recent guidelines 1.
Management of Lagophthalmos
To manage the patient's condition, the following steps should be taken:
- Aggressive lubrication with preservative-free artificial tears every 1-2 hours during the day
- A thicker lubricating ointment at night, such as Refresh PM or Lacrilube
- Use of moisture chamber goggles during the day and taping the eyelids closed or using a moisture chamber eye shield during sleep
Importance of Prompt Evaluation
If symptoms of corneal exposure, such as pain, redness, or decreased vision, develop, prompt ophthalmology evaluation is necessary 1.
Treatment of Underlying Condition
The patient's blepharitis should be managed with warm compresses, eyelid cleansing, and other treatments as recommended by the guidelines 1, which may include:
- Warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions
- Eyelid cleansing, including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands
- Topical perfluorohexyloctane, antibiotics, antiparasitic medication, or topical anti-inflammatory agents, as needed
Referral to Specialist
For persistent lagophthalmos beyond 2-3 weeks, referral to an oculoplastic surgeon is warranted to evaluate for possible surgical correction, such as gold weight implantation or lateral tarsal strip procedure 1.
From the Research
Lagophthalmos Treatment Options
- The patient, Bleph, has a 3mm lagophthalmos, which is a condition where the eyelid cannot fully close, potentially leading to exposure keratopathy and other complications 2, 3, 4.
- Studies have shown that the use of artificial tears, such as those containing lipidure and hypromellose, can be effective in reducing the severity of lagophthalmos and improving symptoms of dry eye disease 2, 5, 6.
- Another treatment option is the use of hyaluronic acid gel, which can be injected into the upper eyelid to help improve closure and reduce lagophthalmos 3, 4.
- The effectiveness of these treatments may vary depending on the individual patient and the severity of their condition, and further research is needed to fully understand their benefits and limitations 2, 3, 5, 4, 6.
Treatment Efficacy
- A study published in 2021 found that the combination of polyethylene cover and artificial tear drops can be clinically effective in reducing the severity of lagophthalmos 2.
- Another study published in 2009 found that injecting hyaluronic acid gel into the upper eyelid can significantly improve lagophthalmos and reduce exposure keratopathy 3.
- A 2024 study found that artificial tears containing lipidure and hypromellose were effective and safe for the treatment of moderate dry eye disease in contact lens wearers 5.
- A 2013 study found that hyaluronic acid gel was effective in reducing paralytic lagophthalmos and controlling keratopathy in patients with temporary facial palsy 4.
Future Research Directions
- Further studies are needed to compare the efficacy and safety of different treatment options for lagophthalmos, including artificial tears and hyaluronic acid gel 2, 3, 5, 4, 6.
- Research is also needed to better understand the mechanical and pharmacological roles of each ingredient in tear substitutes and their effects on the ocular surface 6.