Lots of different things could cause dry eyes. Maybe the air is dry. Perhaps you don’t blink enough when you’re working at a computer. Or it could be that your hormone levels are changing.
It’s also possible that a condition you might not have heard of, called lagophthalmos, is why your eyes are dry.
Lagophthalmos is a condition where you don’t fully close your eyelids. That means part of your eye is exposed, so it can become dry, red and feel irritated or gritty.
“The most common type is nocturnal lagophthalmos, which is when your eyelids do not close fully during sleep,” said Dan Twelker, an optometrist with Banner – University Medicine. If your eyes are partially open when you’re sleeping, your tears evaporate more rapidly. That means your eyes are drier when you wake up.
“But there can be other causes, including scarring from trauma,” Dr. Twelker said.
The condition can range from mild to severe. In mild cases, there’s only a tiny gap between the eyelids and only a small amount of the eye surface is exposed. With more severe cases, the gap is bigger and more of the eye is uncovered.
Lagophthalmos symptoms
Dry eyes are the most common symptom. You might also notice:
- Irritation can range from a feeling of grittiness to burning or itching.
- Redness, especially when you wake up.
- Blurry vision, since long stretches of dry eyes may make your vision less clear.
- The sensation of having something in your eye. “It could feel like an eyelash or dust in your eye,” Dr. Twelker said.
- Excessive tearing, since for some people the eye overcompensates for the lack of moisture.
If you have any of these symptoms, talk to an eye care provider. Diagnosing lagophthalmos early can get you on a treatment path and help prevent complications.
Causes and risk factors
Some of the leading causes of lagophthalmos are:
- Facial nerve damage, which could come from trauma, surgery, infections such as Bell’s palsy or neurological conditions like stroke.
- Thyroid eye diseases, such as Graves’ disease.
- Eyelid malformations or defects.
- Fractures to the bones surrounding the eye, known as orbital fractures.
- Tumors or growth close to the eyelids or their nerves.
- Eyelid surgeries, which may damage the nerves or muscles that help you close your eyes. This damage can be temporary or permanent.
You’re more likely to develop lagophthalmos if you:
- Are older.
- Have facial trauma.
- Have certain neurological conditions, such as multiple sclerosis or stroke.
- Have abnormal eyelid anatomy.
How lagophthalmos can affect your health
Your eyelids protect your eyes and keep them moist and lubricated. When they don’t close properly and your eyes become dry and irritated, you can develop scratches on your cornea. You may notice pain, brightness or sensitivity to light.
And when your cornea isn’t healthy, you are more likely to develop infections, such as bacterial or viral keratitis. These infections can be uncomfortable, cause inflammation and lead to vision loss if you don’t have them treated quickly.
Lagophthalmos can also lead to blurry vision and fluctuations in how clearly you can see. Plus, being uncomfortable and having chronic red eyes can affect your mental well-being. You may feel anxious or frustrated and have a lower quality of life.
“Lagophthalmos can even cause insomnia,” Dr. Twelker said.
Diagnosing lagophthalmos
To diagnose this condition, you’ll usually see a health care provider who specializes in eye care, such as an ophthalmologist or an optometrist.
“Sometimes we need help from a trusted family member or close friend to observe the eyelid position while sleeping, to see if there is incomplete eyelid closure,” Dr. Twelker said.
Your health care provider will likely:
- Ask about symptoms such as dryness, irritation or trouble fully closing the eyelids.
- Determine if other medical conditions or previous surgeries might be responsible for your symptoms.
- Check for signs that your eyelids are not positioned properly or are weak or paralyzed.
- Assess how far you can close your eyes.
They may also:
- Conduct a slit-lamp examination. This exam uses a specialized microscope to check the cornea for dryness, scratches or other issues.
- Evaluate the quality and quantity of your tears with tests such as tear break-up time or Schirmer’s test.
- Check your facial muscle strength, reflexes and sensation, if they think you might have underlying neurological conditions or facial nerve damage.
- Refer you for imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT), especially if they think you might have a fracture or tumor that’s causing your symptoms.
How to manage lagophthalmos
There are various options for treating lagophthalmos. Your eye care provider can make recommendations based on your symptoms and how severe your condition is.
“The most common treatment is to lubricate the eyes, using artificial tears during the daytime and an ophthalmic gel before bedtime,” Dr. Twelker said.
Other options include:
- Moisture-retaining goggles or eye shields you can wear when you’re sleeping to trap moisture around your eyes and reduce evaporation. These devices can be good options for people with severe lagophthalmos.
- Punctal plugs, which are devices that are inserted into the tear ducts, so your tears stay on the surface of your eye instead of draining.
- Prescription medications, such as anti-inflammatory eye drops or immunomodulators, which may reduce inflammation and help you produce more tears.
Sometimes to treat lagophthalmos, you need to treat the condition that’s causing it. That could include surgery to correct the position or the function of your eyelid, rehabilitation to strengthen the muscles in your face and managing other medical conditions.
Lifestyle changes and home remedies
Some lifestyle changes may also help:
- Using a humidifier can help keep your eyes more comfortable.
- Regular blinking exercises throughout the day can help your eyes produce more tears and distribute them across the surface of your eye.
- A diet with fatty fish, leafy greens and nuts gives you omega-3 fatty acids, vitamins A and D and antioxidants that can support your eye health.
- Drinking plenty of water throughout the day can prevent dehydration, which can make dry eyes worse.
The bottom line
If your eyes are dry, irritated and red, you could have lagophthalmos. That’s a condition where you don’t close your eyes fully. It’s more likely to happen when you’re sleeping, but it could also happen in the daytime.
If you’d like help figuring out what’s causing your dry eyes, reach out to an eye care expert at Banner Health.
