Lagophthalmos

Lagophthalmos is when the eyelids do not close completely, allowing exposure of the cornea, especially while sleeping. This can lead to dryness, eye irritation and/or pain, burning, foreign body sensation, redness, blurry vision or even reflex tearing. If the cornea becomes eroded from the exposure over a long period of time, permanent scarring of the cornea and vision loss can develop. A common cause of lagophthalmos is cranial nerve VII palsy. This nerve controls facial expression, including raising the eyebrows, raising the angle of the mouth and closing the eye. Another common cause of lagophthalmos is thyroid eye disease. Lagophthalmos can develop after eyelid surgery if too much skin has been removed or significant scar contraction occurs. Depending on the cause and chronicity of the lagophthalmos, different procedures can be performed to help bridge the gap between the upper and lower eyelid by bringing the upper eyelid down and/or the lower eyelid up. For lagophthalmos due incomplete closure of the upper eyelid, a gold or platinum implant may be placed in the upper eyelid to weigh the eyelid down and complete the closure of the eyelid. For lagophthalmos due to the lower eyelid, a suture can be placed at the lateral canthus (the outside corner of the eye) through a small incision and tied to the orbital rim, and a skin graft and/or collagen implant is used to lengthen the eyelid vertically–both are in effort to elevate the lower eyelid up.