Taping the eyelids closed at night or using commercially available eyelid weights can go a long way in addressing exposure keratitis secondary to lagophthalmos.īoth options should be done under a practitioner’s supervision. Because the condition occurs at night, some of the best strategies would be implemented at that time.Īddressing the environment in which patients sleep can be helpful, such as using a humidifier. Once we determine that a patients has lagophthalmos, there are a few options for contact lens patients. A slit lamp or transilluminator evaluation of the intrapalpebral area will be able to help determine whether lagophthalmos is present. Ask patients: Do you notice a substantial difference in symptoms in the morning as opposed to in the evening? Are there differences between the days that you wear contact lenses and the days that you do not?Ĭan you come in for a morning appointment? Practitioners can also try to simulate sleeping in the office by asking patients to gently close their eyes.
As always, an effective case history in connection with a problem-focused exam can help uncover those subtle diagnoses. Practitioners definitely have options to offer to patients who have nocturnal lagophthalmos, but the key is identifying the problem. While both artificial tears and ointment assist with lubricating the ocular surface, ointments may prove to be more effective, especially when used in conjunction with eyelid taping or with eyelid weights. Both options should be done under a practitioner’s supervision. Taping the eyelids closed at night or using commercially available eyelid weights can go a long way in addressing exposure keratitis secondary to lagophthalmos. When you have a suspicion of nocturnal lagophthalmos that a pacurs at night, some of the best strategies would be implemented at that time.Īddressing the environment in which patients sleep can be helpful, such as using a humidifier. To accurately identify these patients, practitioners need to do more. We can identify lagophthalmos from inferior superficial punctate keratitis but, if patients have only a mild case and their appointment time is late afternoon or evening, those corneal finding may no longer be present. Clinically, we can also encounter challenges. In reality, these are symptoms of almost every dry eye patient. When a patient presents with symptoms of foreign body sensation, hyperemia, and reduced acuity, practitioners are not likely to routinely jump to a diagnosis of lagophthalmos. In addition, symptoms typically are not terribly helpful.
Subtle cases are not easily identified in our exam lane either, because many of these patients can have normal voluntary lid closure during evaluation (Tsai et al, 2009). Unless patients have been told by others, quite often they may suffer from nocturnal lagophthalmos and not be aware of it.
While severe cases can usually be readily diagnosed, we may find it challenging to diagnose the more subtle cases, which can masquerade as dry eye disease. Treatment is multipronged and may include minor procedures or ocular surgery to correct the lid malposition natural, topical or oral agents and punctal plugs to manage ocular surface effects.Ĭorrect and timely diagnosis allows greater opportunity for relief of patient suffering and prevention of severe ocular surface pathology, as well as educated planning for future ocular surgical procedures. There are a variety of causes of lagophthalmos, grouped as proptosis/eye exposure etiologies and palpebral insufficiency etiologies.Īlthough obvious lagophthalmos is usually detected, it is sometimes difficult to recognize obscure lagophthalmos, due either to eyelash obstruction or overhang of the upper lid anterior and inferior to the most superior portion of the lower lid in a closed position.Ī diagnosis can usually be made with a focused history and slit lamp examination. Lagophthalmos is associated with exposure keratopathy, poor sleep, and persistent exposure-related symptoms. This can result in a range of conditions from mild epithelial changes to severe exposure ulcers (Katz and Kaufman, 1977). Nocturnal lagophthalmos is the inability to close the eyelids while sleeping.
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