Lagophthalmos

Lagophthalmos is inability to fully close the upper eyelid with diminished ability to blink and impairment of the tear duct pumping system. Normally each blink spreads the tear film over the eye's surface, allowing a continuous layer of moisture. If the eye is not closing properly, its surface can dry out, damaging the cornea.

What causes Lagophthalmos?

Various conditions can cause partial or complete paralysis the muscle controlling upper eyelid movement. Rarely, lagophthalmos is present at birth. More commonly it is associated with paralysing conditions such as Bell's Palsy or stroke. It can also occur after head trauma, head surgery, infections and tumours.

What treatments are available?

Treatment depends on how long the lagophthalmos is expected to last. In some cases it will be long-standing or permanent but often the goal is to keep the eye healthy while the condition resolves on its own.

Medical (short-term) treatment is aimed at keeping the eye moist to protect the cornea. This is done via frequent instillation of ointments or drops. Ointments tend to be more effective; however, they may cause blurry vision for a while after they are applied.

Surgical (longer term) treatment is aimed at closing the eyelids to prevent corneal dryness. Several surgical procedures can be used:

• Lateral tarsorrhaphy is the usual method. It involves stitching the outer edges of the upper and lower eyelids together. It can limit side vision.
• Medial tarsorrhaphy is generally used as a last resort, as it is more disfiguring than lateral tarsorrhaphy The eyelids are joined at the inner corners
• Tarsorrhaphy can be temporary or permanent.
• The lower eyelid can be elevated using a face lift or an implant
• A light weight can be inserted into the upper eyelid, allowing it to close more easily.