What is Lagophthalmos?
Lagophthalmos is an ophthalmologic condition in which the affected patient is unable to close his or her eyelids completely, either during sleeping or during normal course of the day. Lagophthalmos results in the person having diminished blink, inability to close the eyes completely, and impairment of the lacrimal system which produces tears. Common presenting feature of Lagophthalmos is persistent tearing of the eyes and a weak eyelid. Some of the common causes for Lagophthalmos are trauma, infections, and tumors. Treatment for Lagophthalmos is both conservative as well as surgical which has been discussed in detail below.
What are the Causes of Lagophthalmos?
When it comes to causes of Lagophthalmos, the root cause of this condition is dysfunction of the seventh cranial nerve also known as the facial nerve. The function of this nerve is to control the movement of the muscles which move the eyebrows up and down. Some of the reasons for dysfunction of the facial nerve are:
Lagopthalmos Caused Due to Trauma: This can be incurred due to a direct blow to the face with a hard object such as in cases of domestic violence or a motor vehicle crash, getting injured during a bout of boxing or while playing contact sports like football and rugby.
Lagopthalmos Caused Due to Graves Disease: This is a medical condition in which there is overproduction of the thyroid hormone. This increase in the thyroid hormone can also result in impairment of the facial nerve.
Heredity: Genes also play a role in dysfunction of the facial nerve resulting on Lagophthalmos.
Lagopthalmos Caused Due to Complications of Surgery: Sometimes Lagophthalmos can be caused as a result of complications arising after an eyelid surgery.
Lagopthalmos Caused Due to Bell Palsy: This is quite a common cause of Lagophthalmos.
What are the Symptoms of Lagophthalmos?
The classic presenting features of Lagophthalmos are:
- Inability to fully close the eyelids is a primary symptoms of Lagopthalmos
- Redness of the eyes
- Persistent tearing from the eyes
- Blurred vision
- Eye irritation, especially at night.
How is Lagophthalmos Diagnosed?
The diagnosis of Lagophthalmos begins with taking a history of the patient so as to ascertain the etiology. The patient should be forthright in telling the physician about any history of injury to the face such as an assault or a sporting injury. The patient should also inform the physician about any past history of infection.
The next step towards the diagnosis of Lagophthalmos is to test the eyelids. This is done by asking the patient to look down and gradually try and close the eyes. If the patient is not able to close the eyes completely then a diagnosis of Lagophthalmos is confirmed. The degree of Lagophthalmos needs to be measured to formulate a treatment plan.
How is Lagophthalmos Treated?
Treatments for Lagophthalmos are both conservative as well as surgical. When it comes to conservative treatment, stepwise approach is recommended depending on the duration and severity of Lagophthalmos. The status of the cornea of the patient should be followed closely and observed for any damage.
Conservative Treatment for Lagopthalmos: If there is significant exposure of the cornea due to lagophthalmos then artificial tears can be quite effective if administered frequently so as to supplement the tear film. Apart from this there are also ointments available that can be also used on the surface of the cornea. In case of infection to the cornea then antibiotic therapy will be prescribed. The eye may also be covered with a patch to protect the cornea.
Tarsorrhaphy: This is a surgical procedure performed when recovery of the eyelid closure is anticipated within a few weeks. In this procedure, a part of the eyelid is sutured together to achieve partial closure of the eyelid temporarily and protect the cornea. Once the procedure is done, antibiotic therapy and lubrication is done to treat the cornea. In case if Lagophthalmos is refractory to medical management and temporary tarsorrhaphy, then a permanent tarsorrhaphy is performed. The downside of Tarsorrhaphy is that the sutures that are placed may become loose and cause inadequate coverage of the cornea and it may also not look pleasing to the eye cosmetically.
Gold Weight Implantation: Gold Weights can be implanted into the upper eyelid as a way to treat Paralytic Lagophthalmos. The Gold Weight puts pressure on the upper eyelid and thus the eyelid closes. Gold is used as it does not show up through the thin skin of the eyelid. If the patient has an allergy to gold then platinum is the alternative. The weight of the gold is chosen by placing weights preoperatively and picking up the best one. This procedure does not have many downsides but in some cases migration of the implants and extrusion of the gold has been noted.
Upper Eyelid Retraction: Recession of the upper eyelid retractors is quite an effective procedure in people with Lagophthalmos caused due to upper eyelid retraction.
Lower Eyelid Tightening: The lower eyelid may become lax in cases of facial nerve palsy. A tightening procedure in such cases improves apposition of the lower eyelid and decrease tearing.
- American Academy of Ophthalmology. “Lagophthalmos.” https://www.aao.org/disease-review/lagophthalmos-review
- Mayo Clinic. “Bell’s palsy.” https://www.mayoclinic.org/diseases-conditions/bells-palsy/symptoms-causes/syc-20370028