Lagophthalmos is an eye condition where a patient cannot completely close his eyelids, having to leave the eye cracked open. This can cause problems, as blinking normally sweeps the eye with fresh tear film to keep it lubricated and free of debris and dirt. There are several available treatments, depending on why the patient has lagophthalmos. An ophthalmologist can evaluate a patient and make treatment recommendations.
One common cause is nerve damage. Bell's palsy, facial trauma, and other conditions can damage the nerves responsible for controlling the eyelids, making it hard for patients to completely close their eyes. The eyelids may also droop, rather than retracting fully. Skin disorders can tighten and pull the skin, posing difficulties with closing the eyes, and sometimes a plastic surgeon removes too much tissue in procedures to improve the appearance of the eyelids, and patients cannot close them completely. Surgeons are careful to map out surgical plans at the start to avoid this complication, but it is a potential risk, and patients who notice tightness or trouble closing their eyes should talk to their surgeons.
In a lagophthalmos patient, a doctor may recommend eyedrops for lubrication and cleaning to keep the patient comfortable in the short term. Medications can also be useful for treating underlying medical issues. Sometimes, things like nerve damage resolve over time as the patient's body recovers, and the eyelids return to normal. If they do not, a surgeon can implant eyelid weights. These weights will pull the eyelid closed when people relax, covering the eye completely.
Leaving lagophthalmos untreated can result in dry eyes, blurry vision, and complications like infections in the cornea. Patients may also experience sleep disruption. It is important to receive a full medical evaluation to learn more about the cause, as it could be a sign of increasing severity in an underlying chronic disease, and it is important to catch changes in status early. It may be possible to intervene and prevent damage if a patient is alert.
Patients who need eyelid weights for lagophthalmos may later opt to remove them, although these surgical implants are very stable and should not cause any problems for the patient. Commonly, a surgeon uses gold, as it is nonreactive and heavy enough to serve as an effective weight. The implant should not be visible and will not chafe or irritate the eye. Initially, patients may need to wear an eyepatch after surgery to give the eye a chance to heal, but can later remove it and carry on normally.
