Lagophthalmos is the name given to incomplete closure of the eyelid. Sometimes the symptom leads to widening of the palpebral fissure.
What is lagophthalmos?
Lagophthalmos refers to incomplete closure of the eyelid. The symptomatology falls within the scope of ophthalmology and neurology. In some cases, lagophthalmos may result in widening of the eyelid fissure. The term lagophthalmos originates from Greek and means “hare’s eye” in German translation. Thus, lagos means “hare” while ophthalmus means “eye.” In most cases, lagophthalmos appears in only one eye. However, it can also occur in both eyes. From a distance of three millimeters and in combination with a strong lacrimal gland hyposecretion, there is a risk of keratitis (corneal inflammation) without appropriate therapy. In the worst case, there is a risk of ulceration (ulceration) and loss of the affected eye.
Causes
The causes of lagophthalmos vary. The most common cause of the eye disease is considered to be peripheral paralysis of the facial nerve, which is the 7th cranial nerve. In medicine, this is called facial nerve palsy. This affects the eye muscle Musculus orbicularis oculi, which has the shape of a ring. Possible origin of the paresis can be a stroke. However, in some cases lagophthalmos is also caused by scars that result in shortening of the eyelids. The same is true for deformation of the affected eyelid due to traumatic damage. Sometimes the protrusion of the eyeball (exophthalmos) is responsible for lagophthalmos. Other conceivable causes of lagophthalmos include ectropion (malposition of the eye), congenital malformations such as a coloboma, endocrine orbitopathy occurring in Graves’ disease, zoster oticus, polyneuritis, meningitis, cerebellopontine angle tumor, or the occurrence of coma. In addition, in rare cases, leprosy on the eyelids leads to a condition called hare’s eye.
Symptoms, complaints, and signs
In lagophthalmos, affected individuals feel as if they have a foreign body in their eye. In addition, the eye shows a burning sensation, which is often experienced as agonizing. In addition, the eye feels dry. The reason for this is the inability of the eye muscle to close the eye completely. It is not uncommon for lagophthalmos to cause the cornea to dry out, which doctors refer to as xerophthalmia. There is a risk of corneal inflammation and ulceration. If the patient attempts to close the affected eye, Bell’s phenomenon appears. This is a temporary rotation of the eyeball in the superior direction. Because lagophthalmos also reduces the blink, this leads to obstructions in tear drainage as well as tear tearing. If a mild form of lagophthalmos is present, a positive eyelash sign sometimes occurs.
Diagnosis and course of the disease
If lagophthalmos is suspected, it is recommended to consult an ophthalmologist as well as a neurologist. The neurologist will clarify whether the symptomatology is caused by paralysis of the facial nerve. At the ophthalmologist‘s office, a thorough examination of the affected eye with a slit lamp takes place. During this procedure, the ophthalmologist inspects the conjunctiva, cornea, and the interior of the eye for possible damage. With timely treatment, lagophthalmos takes a favorable course. Without appropriate therapy, however, complications such as a corneal ulcer are imminent. In a very unfavorable course, loss of the eye may even occur.
Complications
In most cases, lagophthalmos leads to a relatively strong foreign body sensation in the patient’s eye. As a result, it is not uncommon for those affected to suffer from a burning sensation directly in the eye or very dry eyes. Likewise, the eye pain can spread to other regions and further lead to headaches as well. The quality of life of the affected person is significantly reduced by lagophthalmos. Likewise, lagophthalmos can lead to disturbances in concentration and coordination in the patient. It is not uncommon for the field of vision of the affected person to be restricted and for an ulcer to form. Likewise, an inflammation of the cornea can occur, which must be treated by a physician in any case.In most cases, lagophthalmos does not heal itself, so a doctor must be consulted in any case. In most cases, this disease is treated with the help of various ointments and eye drops. No complications occur in this process. However, in severe cases, surgical interventions or taking antibiotics are necessary. Even in these cases there are no complications. The patient’s life expectancy is usually not reduced by lagophthalmos.
When should you see a doctor?
If there is a foreign body sensation in the eye, a doctor should be consulted to determine the cause. If the eyelid cannot be completely closed, it is advisable to discuss this observation with a physician. If small particles from the immediate environment repeatedly enter the eye despite a strong blink, a visit to the doctor is necessary. If eye dryness develops or the eye becomes watery, consultation with a physician should be made. Pain in the eye, itching, discomfort and changes in vision must be examined and treated by a doctor. Disturbances of the eye muscles are a warning sign that should be followed up. If the discomfort causes rubbing of the eye, resulting in redness, the affected person needs medical attention. In case of inflammation in the eye area, irritability or inner restlessness, a doctor should be consulted. If the affected person suffers from sleep disorders, headaches or swelling of the eye, a doctor should be consulted as soon as possible. Changes in the blinking of the eyelids, the formation of an ulcer, and discoloration of the retina should be examined and treated immediately. If tear drainage is impaired or pus forms, a doctor’s visit is advised. The affected person should expect the symptoms to increase without medical attention.
Treatment and therapy
The therapy of lagophthalmos depends on the extent of damage to the cornea. Adequate moistening of the ocular surface plays an important role in the treatment of the disease. For this purpose, an eye ointment or an eye gel can be applied. In some cases, a special watch glass bandage is also used. This is a transparent flap made of Plexiglas, which is equipped with a sticking plaster that encloses it. The watch glass bandage preserves the cornea from foreign influence and drying. Soft contact lenses are suitable as another protective measure against dehydration. In reversible forms of lagophthalmos, since 1993, upper lid loading with lead weights has also been used. Due to their more efficient functional effect and better cosmetics, they are superior to the watch glass bandage and ensure that the patient remains fit to drive. In addition, the application of eye drops can still be performed. If the conservative treatment methods do not lead to improvement and the paralysis does not regress, surgical intervention must be performed. The same applies if major damage to the eye occurs. During the operation, partial closure of the upper and lower eyelids is performed. The patient receives local anesthesia before the procedure. The row of eyelashes is usually preserved during this procedure. The procedure allows for surgical reopening. In irreversible forms of lagophthalmos, it is also possible to permanently implant a weight made of metal in the upper eyelid, which provides closure of the eye. This is especially true after an acoustic neuroma or a parotid tumor. This method was used as early as the 1950s, but then fell into oblivion for a time until it was used again in German eye clinics from 1990 onwards. If corneal inflammation (keratitis) or an ulcer is already present, their treatment is carried out with the help of antibiotics.
Outlook and prognosis
The prognosis of lagophthalmos is favorable. Nevertheless, cooperation with a physician is needed, since spontaneous healing does not occur and self-help options are insufficient. Without treatment, the symptoms are expected to increase. The field of vision continues to narrow, paralysis increases in extent, and overall vision deteriorates. This increases the general risk of accidents in everyday life and the well-being of the affected person is permanently reduced. The various complaints are alleviated within a short time by the administration of medication.These are associated with few side effects, so that good tolerability of the preparations is attested. In rare cases, surgical intervention is required to improve the healing success. If this proceeds without further complications, freedom from symptoms can be documented after completion of the wound healing process. The eyelid opening is surgically restored and thus the functional capacity of the eye is corrected. If the surrounding area is injured during the procedure, the extent of the injury must be taken into account when making an overall prognosis. If there is pus formation in the area of the eye, the risk of sepsis is increased. This is a potential threat to human life. Intensive medical care is necessary or premature death may occur.
Prevention
Prevention of lagophthalmos requires prevention of the precipitating underlying diseases. However, this is not possible in the case of facial paresis or malformation.
Follow-up
In most cases of lagophthalmos, the patient has few to no special aftercare measures available. In this case, the patient should see a physician early on to avoid further complications or further worsening of symptoms. Self-cure is usually not possible in lagophthalmos, so the patient should ideally see a doctor at the first symptoms and signs of the disease. As a rule, the disease itself can be well alleviated by a minor surgical intervention. After such an operation, affected persons should protect and care for their eyes particularly well. In general, stressful or physical activities should be avoided so as not to put unnecessary strain on the body. Likewise, contact lenses can significantly alleviate the discomfort of lagophthalmos, so affected individuals should wear them if prescribed by a physician. If lagophthalmos is caused by a tumor, further regular examinations and checks should be carried out by a doctor after the tumor has been removed in order to prevent the tumors from spreading. However, this disease does not usually reduce the life expectancy of the affected person.
What you can do yourself
Patients suffering from lagophthalmos usually experience severe pain in the area of the affected eye. Therefore, the most important self-help measure is to carefully care for the eye and protect it from further stimuli. This can be achieved, for example, with the aid of a sleep mask, which can be worn by the sufferer at night. The doctor will also prescribe special eye ointments for the patient. These must be applied regularly, and sometimes they can be supplemented with natural remedies. For example, after consulting with the doctor, the remedy arnica can be applied, which relieves inflammation and pain. In case of surgical intervention, rest and bed rest apply. The patient should not subject the eye to any additional stress after the operation and should also take care of the body in order to reduce the risk of secondary infections. In addition, the patient must take the medications prescribed by the doctor. It is advisable to write down any side effects or interactions and to inform the doctor about them. In this way, the medication can be optimally adjusted to the needs of the person affected. In general, with a pronounced lagophthalmos, regular visits to the doctor should be made.
