Lagophthalmos (Unable to Blink Eyelids) : Diagnosis and Treatment Options

Lagophthalmos(Unable to Blink Eyelids) is a condition that prevents the eyes from closing completely. If the problem only occurs when you sleep, it's called nocturnal lagophthalmos. The condition itself is usually harmless but leaves the eyes vulnerable to damage

The space between the upper and lower lids exposes the ocular surface, causing dryness problems that can aggravate and threaten the integrity of the eye and the quality of vision

Not being able to blink eyelids results in:

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Greater evaporation of tears
Poor distribution of the tear film
Disruption of the mucin layer component of the tear film
Drying of the cornea
Rupture of the ocular surface

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Causes of Lagophthalmos (Unable to Blink Eyelids)

Lagophthalmos is often caused by failure of the orbicularis muscle function.
Paralysis or spasticity of the facial intracranial nerve affecting the orbicularis oculi muscle can lead to lagophthalmos.
Excessive bulge of the globe in orbit, seen in conditions like proptosis or buphthalmos, can accompany Unable to blink eyelids.
Structural issues, such as inadequate vertical dimension of the eyelids due to scarring or atrophy, can also cause lagophthalmos.
Temporary lagophthalmos may occur in babies with a collodion membrane restricting eyelid movement.

Other causes can be:

Injury, either from blunt trauma or deep cut
Stroke
Tumors, especially acoustic neuromas
Moebius syndrome
Autoimmune conditions, such as Guillain-Barré syndrome
Scars from burns, injuries, or certain medical conditions
Eyelid surgery
Floppy eyelid syndrome

Diagnosis of Lagophthalmos (Unable to Blink Eyelids)

Medical Evaluation:

Your doctor will conduct a comprehensive medical history review and physical examination to identify the underlying cause of unable to blink eyelids. Inform your doctor about any recent injuries or infections.

Diagnostic Tests:

Tests may include:
- Looking down while attempting to close your eyes.
- Measurement of space between eyelids.
- Recording eyelids blink frequency and assessing eye closure extent.
- Evaluating force exerted during eye closure to determine facial nerve involvement.

Slit-lamp Examination:

An ophthalmologist may conduct a slit-lamp examination to detect interpalpebral punctate epithelial keratopathy, varying with cornea position during sleep in nocturnal lagophthalmos patients.

External Examination:

Your doctor will assess complete eyelid blink closure by gently instructing you to close your eyes.

Levator Muscle Function:

Evaluation of levator muscle function during eyelid excursion.
Lagophthalmos may occur despite normal vertical skin mobility.

Nerve Dysfunction Assessment:

Acute seventh intracranial nerve dysfunction due to conditions like Bell's palsy can cause unable to blinkeyelids
Manual distraction of eyelids during forced closure may reveal orbicularis oculi muscle weakness.

Fluorescein Eye Stain Test:

Your doctor may use a fluorescein eye stain test to identify eye damage signs.

Treatment of Lagophthalmos (Unable to Blink Eyelids)

Non-surgical Treatment:

Non-surgical options focus on symptom management:
- Apply artificial tears(Visine Pure Tears, Refresh) during the day to prevent dryness and itching.
- Use protective ointment on the cornea to prevent scratches.
- For nocturnal lagophthalmos, use moisture goggles to hydrate eyes while sleeping.
- Keep a humidifier nearby during sleep for added humidity.
- Consider placing small weights on eyelids or using surgical tape to keep them closed.

Surgical Treatment:

Surgical options depend on the underlying cause:
- Proptosis: Manage with orbital decompression or eyelid lengthening procedures.
- Cap Shortening: Reconstructive soft tissue surgery may be necessary.
- Inadequate Vertical Skin: Replacement with flaps or skin grafts may be required.
- Symblepharon: Treat by releasing adhesions and rebuilding the cul-de-sac with a mucous membrane graft.
- Paralysis of Orbicularis Oculi Muscle: Consider measures to reduce evaporation or tarsorrhaphy for severe cases.
- Lower Eyelid Retraction: Treat with spacer placement to elevate and support the eyelid, using materials like donor sclera, cartilage, or mucosa.

Complications with the Lagophthalmos (Unable to Blink Eyelids)

Complications of Untreated Lagophthalmos:

Leaves eyes vulnerable to scratches and injuries due to lack of eyelid protection.
Continuous eye exposure can lead to exposure keratopathy, resulting in corneal swelling or thinning and potential corneal ulcers.

Complications of Lagophthalmos Surgery:

Surgical treatments may have complications:
- Cartilage grafting can result in permanent scarring.
- Gold-weight implants may migrate from their original position.
Follow post-surgery instructions from your doctor to prevent additional problems.

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Prevention of Lagophthalmos

Lagophthalmos cannot be prevented in most cases unless it results from eyelid retraction after blepharoplasty surgery or other surgical scars.
It is crucial to detect unable to blinkeyelids to assess any potential risks to vision or eye health.
Necessary measures should be taken promptly to treat lagophthalmos once detected.

Citations

https://www.sciencedirect.com/science/article/abs/pii/S138824570400416X

https://www.mdpi.com/2076-2615/9/8/562

https://movementdisorders.onlinelibrary.wiley.com/doi/abs/10.1002/mds.870090404

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1. What Causes Lagophthalmos?

Facial nerve paralysis (paralytic lagophthalmos) is the primary cause of unable to blinkeyelids but also happens during trauma or surgery (cicatricial lagophthalmos) or during sleep (nocturnal lagophthalmos).

2. Is nocturnal lagophthalmos genetic?

It can be inherited, so if you sleep with your eyes open, your baby might as well (but most kids outgrow it when they get older). However, if you still experience nocturnal lagophthalmos in adulthood, it is important to see a doctor.

3. How do I fix nocturnal lagophthalmos?

Your doctor may prescribe you eye drops and ointments if you have nocturnal lagophthalmos, which protect your eyes from drying out.

4. What should I do if I experience the inability to blink eyelids?

If you notice any changes in your ability to blink or any associated symptoms such as eye discomfort vision changes, or facial weakness, it's important to seek medical advice promptly for evaluation and appropriate management.

5. Can lifestyle changes help manage the inability to blink eyelids?

While lifestyle changes may not directly treat the underlying cause, they can complement medical treatment. These may include practices such as maintaining eye hygiene, using lubricating eye drops, and protecting the eyes from environmental irritants.

6. Is the inability to blink eyelids a common problem?

The frequency of this issue may vary, and it can occur due to a range of factors. Consulting with a healthcare professional can provide personalized insights into the prevalence and management of the condition.