Lagophthalmos

👁️ Lagophthalmos

🔍 Definition

Lagophthalmos is the inability to fully close the eyelids, leading to exposure of the cornea and conjunctiva. This can cause dryness, irritation, and even corneal ulceration if severe.

🧠 The term comes from the Greek word lagos, meaning hare — inspired by how hares sleep with their eyes partially open!

 

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🧬 Causes of Lagophthalmos

Type	Common Causes
Paralytic	Facial nerve (CN VII) palsy (e.g., Bell’s palsy, trauma, tumors)
Nocturnal	Eyelids don't close fully during sleep (idiopathic or post-surgery)
Cicatricial	Eyelid scarring (burns, trauma, Stevens-Johnson syndrome)
Mechanical	Eyelid retraction from thyroid eye disease, tumors
Post-surgical	Overcorrection from blepharoplasty (cosmetic eyelid surgery)

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👀 Clinical Features

Feature	Description
Inability to close eyelids completely	Especially noticeable during blinking or sleep
Lag sign	Gap between eyelids when attempting closure
Dryness & irritation	Due to corneal exposure
Tearing (paradoxical)	From reflex lacrimation
Redness, foreign body sensation	Often from exposure keratitis
Exposure keratopathy	Punctate epithelial defects, ulcers, infection

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🩺 Diagnosis

• Clinical observation – ask patient to close eyes slowly and gently

• Check Bell’s phenomenon – protective upward rotation of eyeball when eyelids close

• Slit-lamp exam – assess corneal surface

• Fluorescein stain – highlights corneal epithelial damage

• Facial nerve testing – especially if palsy is suspected

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💊 Treatment

🔹 Conservative Management (mild to moderate)

Method	Purpose
Lubricating eye drops/gel	Maintain moisture during day
Lubricating ointment at night	Prevent drying overnight
Moisture goggles / patching	Protect eye during sleep
Taping eyelids closed	Temporary solution for nighttime lagophthalmos

🔹 Surgical Management (severe or persistent)

Procedure	Indication
Tarsorrhaphy	Temporary or permanent partial lid closure
Gold/platinum weight implant in upper eyelid	Helps eyelid close by gravity (for CN VII palsy)
Skin grafts / lid reconstruction	For cicatricial lagophthalmos
Lower eyelid tightening	Helps protect cornea by elevating lid

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⚠️ Complications

• Exposure keratitis

• Corneal ulcer

• Scarring and vision loss

• Chronic conjunctivitis

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🧠 Mnemonic: “LAG = Lid Ain’t Going (all the way)”

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🧾 Quick Summary Table

Feature	Lagophthalmos
Main issue	Incomplete eyelid closure
Common cause	Facial nerve palsy
Symptoms	Irritation, tearing, dryness, redness
Risk	Corneal exposure → ulceration
Treatment	Lubrication, tarsorrhaphy, lid weights

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Would you like:

• A visual diagram showing lagophthalmos and corneal exposure?

• A Bell’s palsy + lagophthalmos case scenario?

• Or a flowchart of management?