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Eyelids Not Closing - Eyes Staying Open During Sleep - Lagophthalmus

The most important task of the eyelids is to close the eye during sleep. Opening and closing, which is every 30 seconds with the blink reflex during the day, is observed as only closing during sleep. While the upper and lower eyelid opener (retractor) muscles are different muscles, the orbicular muscle is the muscle that closes both eyelids (protractor). Therefore, the eyelids are open when the opening muscles are active (when awake during the day), and the eyelids are closed when the orbicular muscle, which closes the eyelids, is active (while sleeping at night). This continues with a balanced system.

What Happens If Eyelids Do Not Close Eyes During Sleep?

In cases where the eyes cannot be closed during sleep for any reason, very serious eye problems are encountered. Since there is no blink reflex during sleep, the eye remains exposed and the eye surface, especially the cornea and conjunctiva, dries up (exposure keratopathy).

 

Image-1: Lagophthalmos

 

With this drying, epithelial peeling, loss of transparency (locoma), corneal keratinization will develop in the cornea.

Why Eyelids May Not Be Closed?

Lagophthalmus can sometimes be congenital, but it is often acquired. Facial paralysis (facial nerve paralysis) constitutes the majority of acquired cases. Facial paralysis can be temporary or permanent. Among other reasons, scars due to trauma may also prevent the closure of the lids. Deep skin infections may also prevent closure. Apart from these, lagophthalmos may develop as a result of eyelid deformities due to nerve damage (denervations) on the basis of leprosy.

What Can Be Done to Close the Eyelids?

As Lagophthalmus and the problems it will cause permanent defects, It is obligatory to make the eyelids so that they close the eye during sleep as soon as possible. The function of the eyelids should be restored again. Therefore, in transient facial paralysis, the eyelid should be closed with eye ointment and plaster before sleeping at night

Drying of the cornea should not be allowed. Different methods can be used in permanent facial paralysis. Stitching the eyelids together from the outside (lateral tarsoraphy) or near-total tarsoraphies can be performed. In addition, gold implants which increase the weight of the eyelid and enable it to be closed can be placed These operations will take 30-45 minutes. It has no notable complications. Rarely, a revisional second surgery may be required. Full recovery is achieved in 1-2 weeks.

Is Physician Preference Important for Closing Eyelids?

Big problems can arise from small issues. For this reason, it is essential to plan effective interventions in a timely manner. Deciding, applying and following the surgical procedure to be applied definitely requires experience. Surgery and follow-up of a patient with lagophthalmus must be performed by an oculoplastic surgeon.

Frequently Asked Questions

1What are the consequences of not closing the eyelid during sleep?
Since there is no blink reflex during sleep, the eye remains exposed and the eye surface, especially the cornea and conjunctiva, dries up (exposure keratopathy). With this drying, epithelial peeling, loss of transparency (locoma), corneal keratinization will develop in the cornea.
Eyelids Not Closing-Eyes Staying Open During Sleep-Lagophthalmus
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