What Causes One to Sleep With Eyes Open

There are many people whom we see who do not close their eyes completely when they sleep. It is medically termed as nocturnal lagophthalmus. There is very limited data as to what percentage of population actually have this condition, but whatever data is available it seems that this is quite common. Some studies suggest that anywhere from 5-50% of people may sleep with their eye open. It is generally seen in adults but in very rare cases affects children as well.^[1,2,3]

The alertness of a person can be judged by the way the eyes respond. Closing the eyes when sleeping not only gives the eyes the rest it needs it also keeps the eyes moist and protects the surface of it. While sleeping, a closed eye protects any exposure to light at night. This is vital for a restful sleep as light triggers the brain to be awake and alert affecting proper rest to the body while sleeping.^[1,2,3]

People who sleep with their eyes open tends to wake up with their eyes dry and tired. Sleeping with eyes open can even cause severe eye problems. Experts believe that the cause of sleeping with eyes open lies in the facial nerve or muscles that keep the eyes open. Any problems with these nerves or muscles results in the inability of a person to keep the eyes closed when sleeping.^[1,2,3]

Sometimes, any issue with the skin around the eyelids may also interfere with proper closing of the eyes. Sleeping with the eyes open makes a person susceptible to numerous eye infections and can also cause significant damage to the eyes. The person may experience vision disturbances, eye irritation and burning, photophobia, foreign body sensation in the eye, and poor quality of sleep. Many people do not even realize that they sleep with their eyes open until somebody informs them about it.^[1,2,3]

This article highlights some of the potential causes and treatment options for nocturnal lagophthalmos or sleeping with the eyes open.

As stated, the primary reason for a person to sleep with the eyes open is because of issues with the facial nerves or muscles. Sometimes, an abnormality of injury to the skin over the eyelid also can impact the ability of the person to close the eyes fully. At times, the muscles around the eyes become weak or paralyzed. This is a medical condition named orbicularis oculi and is yet another reason for a person to sleep with the eyes open.^[3]

Orbicularis oculi is generally caused due to bell palsy, stroke, certain autoimmune conditions, and some types of tumors. Trauma or injury around the eyes can also cause the facial nerves and muscles to become weak resulting in a person to sleep with the eyes open. Rarely, nocturnal lagophthalmos can also be caused due to infections like mumps, Lyme disease, chickenpox, leprosy, and polio. In some cases, people suffering from Grave ophthalmopathy which is a condition where the eyes bulge outwards also affect the ability of a person to close their eyes fully causing nocturnal lagophthalmos.^[3]

Some people have very thick eyelashes. This also at times can be a cause of a person sleeping with the eyes open even though this is very rare. Some experts believe that genetic makeup may also have a role to play in some people sleeping with their eyes open.^[3]

There are quite a few treatment options for nocturnal lagophthalmos in the form of medications like eyedrops, artificial tears to keep the eyes moist, and ointments to prevent scratches in the eyes. Moisture goggles are also something that is effective for people who sleep with their eyes open. They work by keeping the eyes moist when sleeping. Some people sleep with the humidifier on to keep the surrounding air moist. This is also quite effective in preventing dry eyes that result due to sleeping with eyes open.^[3]

Some ophthalmologists recommend adding weight to the upper eyelid so that the eye closes completely when sleeping. One can also use surgical tape to externally close the eye when sleeping. There are also a variety of surgical procedures available as treatment options but is reserved only for severe cases. One surgery involves adding a gold implant to the upper eyelid which acts as weight and allows the person to close the eye when sleeping.^[3]

This procedure involves making an incision just above the eyelashes and the implant is inserted. The implant is fixed with stitches. Antibiotic ointment is then applied for the wound to heal. However, the surgery may cause swelling, discomfort, erythema, and bruising but all this will fade away as the wound heals. If treatment is not given for people who sleep with their eyes open then it may result in some serious issues including loss of vision, infections, and corneal ulcers.^[3]

Sleeping with the eyes open also is connected with poor sleep quality. A person will not get a restful sleep due to nocturnal lagophthalmos. The duration of the sleep will also not be adequate due to persistent discomfort. Thus, it is recommended for people who sleep with their eyes open to consult an ophthalmologist to find a solution to the problem to prevent any undue complications and get a better quality of sleep.^[3]

In conclusion, sleeping with eyes open is quite common and as much as 20% of population in the United States have it. It is medically termed as nocturnal lagophthalmos. The exact cause of this condition is not well known but experts believe that problems with facial muscles or nerves may be the reason behind it. Sleeping with the eyes open generally is not a cause for concern but it definitely is responsible for a person having dry eyes and getting poor quality of sleep.^[1,2,3]

If not treated for long time, it also increases the risk for a person getting infection, corneal ulcers, or even loss of vision. The treatment for sleeping with eyes open is quite easy with the use of eyedrops to keep the eyes moist, adding weight to the upper eyelid to allow it to close when sleeping, or using humidifiers.^[1,2,3]

Nocturnal lagophthalmos also at times can be a sign of an underlying medical condition. Thus it is recommended that a person with this condition should consult with an eye specialist and start treatment for it to prevent any complications that may arise due to sleeping with the eyes open.^[1,2,3]

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