Lagoftalm: Symptoms, Causes, Diagnosis, Treatment and Complications

It refers to the inability of an individual to completely close the eyelids and can cause dry eyes and irritation and even permanent damage.

If the problem only occurs when you sleep, it is called Night Lagoftalmo. The condition itself is usually harmless, but leaves your eyes vulnerable to damage.

It is most commonly found in patients with facial nerve palsy, but it can also be the result of scarring of the eyelids.

Lagoftalmus can also be a symptom of more serious conditions, so it is important to contact your doctor if you have trouble blinking or closing your eyes to sleep.

The eyelids provide protection for the surface of the eye, the cornea. Blinking restores the normal tear film and removes dirt on the corneal surface.

During sleep, the eyelids provide important protection against air and debris that can irritate or damage the cornea.

Night lagophthalmos occurs when the eyelids remain partially open during sleep. It is more common in people with thyroid disease, previous eyelid surgery or with a positive pressure machine in the airways for sleep apnea.

Symptoms include dryness and irritation that usually gets worse in the morning. If left untreated, this condition can cause scarring of the cornea that affects vision.

The treatment includes lubricating eye drops with ointment applied before bedtime and sleeping masks. Occasionally, the condition is severe enough to warrant eyelid surgery.

The long-term prognosis for patients with Lagoftalmos is good, provided that the treatment starts early and is administered regularly.

Symptoms of Lagoftalmo

The main symptom of Lagoftalmo is not being able to close the eyes. If you have Lagoftalmo at night, you may not even know it. Look for these additional symptoms in one or both eyes if you think you have Lagoftalm:

  • Increase in tears
  • Foreign body sensation, which is the sensation that something is rubbing against your eye.
  • Pain or irritation, especially in the morning.
  • The inability to completely close the eyelids is one of the main symptoms of Lagoftalmo.
  • Redness of the eyes
  • Persistent tearing of the eyes.
  • Blurry vision.
  • Eye irritation, especially at night.

Causes

A variety of things can cause Lagoftalmo, but they mostly fall into two categories.

The first is damage to the seventh cranial nerve also known as the facial nerve , which controls the muscles of your eyelid, this is also known as the facial nerve, the function of this nerve is to control the movement of the muscles that move the eyebrows towards up and down. Many things can cause damage to the facial nerve, which include:

Lagopthalmos Caused by Trauma : This may occur due to a direct hit on the face with a hard object such as in cases of domestic violence or a car accident, hurting yourself during a boxing match or when playing contact sports such as football and rugby.

Lagopthalmos caused by Graves’ disease : this is a medical condition in which there is an overproduction of thyroid hormone. This increase in thyroid hormone can also cause a deterioration of the facial nerve.

Inheritance : genes also play a role in the facial nerve dysfunction that results in Lagoftalmo.

Lagopthalmos caused by complications of surgery : sometimes, Lagoftalmo can be caused as a result of complications that arise after eyelid surgery.

Lagopthalmos caused by Bell’s palsy : this is a fairly common cause of Lagoftalmo.

The second group of causes involves damaged eyelids, which can be the result of the following:

  • Leave scars from burns, injuries or certain medical conditions, such as Stevens-Johnson syndrome .
  • Eyelid surgery
  • Eyelid syndrome loose.

The bulging and sunken eyes can also lead to Lagoftalmo.

Diagnosis

Using your medical history and a physical examination, your doctor will try to discover the underlying cause of Lagoftalm. Be sure to tell your doctor about any recent injury or infection that you do not know about.

Your doctor will probably also perform some tests. You may be asked to look down when you try to close your eyes. Your doctor will measure the space between your eyelids with a ruler.

The next step for the diagnosis of Lagoftalmo is to test the eyelids. This is done by asking the patient to look down and slowly try to close their eyes. If the patient can not close the eyes completely, the diagnosis of Lagoftalmo is confirmed.

The grade of Lagoftalmo needs to be measured to formulate a treatment plan.

They can also record how often they blink and how much they close when they do so. The amount of force you use to close your eyes can also help your doctor determine if the facial nerve is involved.

You will probably also do a slit lamp examination, which involves using a microscope and bright light to better see your eyes. Your doctor may also perform a fluorescein test on your eyes to see if there are signs of eye damage.

Treatment

There are several surgical and non-surgical treatment options for Lagoftalm. When it is a conservative treatment, a gradual approach is recommended according to the duration and severity of Lagoftalmo.

The condition of the patient’s cornea must be followed closely and observed for any damage.

Surgical treatment

Changing the position of the upper or lower eyelid can treat or improve the symptoms of Lagoftalm. Another procedure involves implanting gold weights in the upper eyelid, which allows the eyes to close using gravity.

If Lagoftalm is caused by a temporary condition, your doctor may suggest tarsorrhaphy. This involves temporarily sewing the eyelids, either completely or partially.

Keeping the eye covered helps prevent any additional damage while recovering from the underlying condition.

If the underlying condition is going to take a while to heal, your doctor can do a permanent tarsorraphy. They are likely to leave a small opening so you can still see. Once you have healed, your doctor will expand the opening.

For severe Lagoftalmus related to a paralyzed facial nerve, your doctor may suggest a procedure that provides more support for the eyelid. These include nerve and muscle transfers, implants and facial resuscitation procedures.

Tarsorraphy : this is a surgical procedure that is performed when the recovery of the closing of the eyelids is anticipated in a few weeks. In this procedure, part of the eyelid is sutured to temporarily close the eyelid temporarily and protect the cornea.

Once the procedure is performed, antibiotic therapy and lubrication are performed to treat the cornea. In case Lagoftalmo is refractory to medical treatment and temporary tarsorraphy, a permanent tarsorraphy will be performed.

The disadvantage of Tarsorrhaphy is that the sutures that are placed may loosen and cause inadequate coverage of the cornea and may also not be pleasing to the eye cosmetically.

Gold weight implants : gold weights can be implanted in the upper eyelid as a way to treat paralytic Lagoftalmus. The weight of gold exerts pressure on the upper eyelid and, therefore, the eyelid closes. Gold is used since it is not shown through the thin skin of the eyelid.

If the patient is allergic to gold, then platinum is the alternative. The weight of the gold is chosen by placing weights before the operation and selecting the best one. This procedure does not have many disadvantages, but in some cases the migration of the implants and the extrusion of gold have been observed.

Removing the upper eyelid : retraction of the upper eyelid retractors is a fairly effective procedure in people with Lagoftalmo caused by retraction of the upper eyelid.

Tightening of the lower eyelid : the lower eyelid may become loose in cases of paralysis of the facial nerve. An adjustment procedure in such cases improves the apposition of the lower eyelid and decreases the tear.

Non-surgical treatment

Non-surgical treatment options tend to focus on treating the symptoms of Lagoftalm, rather than on the condition itself. Applying artificial tears throughout the day can help prevent your eyes from drying out and getting itchy. You can also apply a protective ointment to the cornea throughout the day to avoid scratches.

If you have Late Night Lagoon, moisture lenses can help protect and hydrate your eyes while you sleep. You can also keep a humidifier nearby while you sleep to get more moisture.

Your doctor may suggest placing small weights on the outside of your eyelids to keep them closed. The surgical tape can provide the same effect.

Is there any complication with Lagoftalmo?

The untreated Lagoftalmo leaves the eyes vulnerable to scratches and other injuries because they are not protected by the eyelids.

The continuous exposure of your eyes can also lead to keratopathy on exposure, which has the same symptoms as Lagoftalm.

Exposure keratopathy can eventually cause your cornea, the clear front of your eye, to swell or thin out. It can also cause a corneal ulcer.

Surgery to treat Lagoftalm can also have complications. Tarsorraphy can leave permanent scars, while gold-weight implants may begin to move away from their original location.

Be sure to follow your doctor’s instructions after surgery to avoid additional problems.

Living with Lagoftalmo

Lagoftalm is not a dangerous condition, but it can lead to eye problems. Work with your doctor to discover the underlying cause. Depending on the cause, Lagoftalmo can be treated with surgery or products to help keep your eyes moisturized and protected.