Did someone inform you that you sleep with your eyes open? Chances are, you are not aware your eyes aren’t entirely closed while you are asleep.
What Is Nocturnal Lagophthalmos?
If you are sleeping with eyes open, or at least your eyelids only partially closed, is termed nocturnal lagophthalmos. It tends to be rather prevalent in young children. However, they often outgrow the condition. It is also common in older adults due to changes in the eyelid tissue.
Nocturnal lagophthalmos can also happen during day time. Patients with this problem do not have a complete blink, so there is always a part of the eye that does not receive sufficient tear lubrication.
When your eyelids do not sufficiently close, your eyes are exposed to the open environment. Because your eyelids lubricate the surface of your eyes, your eyes begin to dry out notably. You may wake in the morning, feeling like your eyes are dry, tired, and itchy.
The Role of Your Eyelids
Your eyelids provide a barrier, permitting tears to lubricate the exterior of your eyes. Along with nutrients, tears have innate antibiotics to kill bacteria and viruses. When the barrier is busted, your eye becomes exposed to the outside atmosphere, and the tear film begins to evaporate almost instantly. When this happens night after night, your eyes may become inflamed, and the conjunctiva and cornea can form ulcers, dry spots, and even scarring if not dealt with.
Causes of Nocturnal Lagophthalmos
It may sound weird, but nocturnal lagophthalmos is actually considered a type of facial paralysis; it comprises the orbicularis muscle in the eyelid and can be permanent or temporary. It can be triggered by multiple things, including infection, Bell’s palsy, stroke, surgery, and trauma.
Lagophthalmos may also develop after undergoing an upper blepharoplasty. Blepharoplasty is a method used to remove excess skin on the upper eyelid (supra-palpebral hooding) that often occurs with aging. The process can help you see better as well as look younger. However, if excessive upper eyelid skin is removed, the lagophthalmos may grow up.
What Nocturnal Lagophthalmos Feels Like
Unless you record(video) yourself while sleeping, you won’t realize you sleep with your eyes open until you experience symptoms. If you go through nocturnal lagophthalmos, you may awaken with dry eye symptoms such as feeling like something is in your eye, pain, redness, and blurry vision. Some people also report increased light sensitivity.
Lagophthalmos is often confused with chronic dry eye syndrome, as symptoms closely resemble each other. Your ophthalmologist will be able to determine if you are suffering from dry eye syndrome by conducting an extensive eye examination.
Your tear generation can be measured to make sure your eyes are secreting adequate moisture. The Schirmer test is applied to measure the tears. During the test, short strips of paper are arranged under your lower eyelids. After a couple of minutes, your physician will measure how much of the strip was absorbed by your tears(1).
Other tests can be examined to figure the nature of your tears. Specialized dyes in eye drops can be employed in your eyes to figure the surface condition of your eyes. Staining patterns on the corneas will figure the amount of time it takes your tears to evaporate.
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Treatment of Nocturnal Lagophthalmos
Treatment generally involves artificial tear eye drops given several times per day along with the installation of ointment or a bland eye gel at bedtime. Ointments can be applied to the cornea at bedtime in extreme cases. Because ointments can make vision blur, most people can only bear them while sleeping.
To avoid the eyelid from opening at night, the medical-grade hypoallergenic tape can be gently employed to the eyelid to keep it closed. A mask worn over the eyes can also help. Your physician may also recommend that you turn off or turn down ceiling fans.
In extreme cases, a gold weight can be activated to the outside of the eyelid or surgically implanted inside the eyelid. The gold weight is adaptable with the body and adapts nature’s gravity to help give a full blink. Another more recent treatment option is scleral contact lenses or corneal gas permeable lenses which cover the cornea and create a more natural and protected environment on the surface of the eye.
What Are the Perils of Sleeping with Your Eyes Open?
People who sleep with their eyes open usually wake to find their eyes red, dry, and disturbed. That’s irritating and uncomfortable in the short term, but there are also possible long term issues that can happen if you regularly sleep with your eyes open.
Sleeping with your eyes open on a regular basis can make your eyes become inflamed and can also lead to ulcers, dry spots, or even scarring on your cornea or the inside of your eyelids.
Don’t be afraid to consult your physician if you might be experiencing lagophthalmos. Sometimes it is difficult to know, as your eyes may be dry due to other causes such as dry eye syndrome. However, the effects of sleeping with open eyes can be severe. Treatments could significantly improve your quality of life.