What is it?

It is an incomplete closure of the eyelids, which produces a constant exposure of the eyeball, with the consequent associated pathology, such as dry eyes and / or corneal alterations.

Causes

The most frequent cause is facial paralysis, either idiopathic (of unknown cause) or secondary to trauma, iatrogenesis (surgeries, dental treatments), etc.
Patients who suffer from facial paralysis present a generalized weakness of the facial muscles, including the orbicularis muscle (responsible for closing the eyelids).
Lagophthalmos can be caused by chemical burns (caustic soda or bleach burns), eye trauma, and even Graves’ disease.

Symptoms

The patient’s eye does not close completely, leaving it partially open.
The symptoms are related to the continued exposure of the eyeball and the excessive evaporation of the tear. Common symptoms include ocular hyperemia (redness), foreign body sensation (grit), itching, stinging / burning. The most serious cases present with corneal involvement, which causes a decrease in visual acuity and pain (it will depend on the degree of corneal involvement).

Diagnosis

Since the most common cause is facial paralysis, its diagnosis and etiology (knowing what its cause was) corresponds to the neurologist or otolaryngologist. The ophthalmologist is in charge of monitoring and treating facial paralysis at an ocular level.

Prognosis

It will be closely related to the injury to the facial nerve and the cause that caused the paralysis. In idiopathic cases (of unknown cause), most patients recover without sequelae.

Treatment

Except for imminent risk to the eye, surgical treatment is not usually indicated until a few months later, when it has been verified that spontaneous improvement is not expected.

In the early stages, treatment is symptomatic, using artificial tears, eye lubricants and / or anti-inflammatory drugs (if necessary). The patient will be recommended to try to perform a forced closure of the eyelids so that the tear is distributed as evenly as possible over the entire ocular surface.

Occlusion of the eye may be recommended, mainly at night.
In the upper eyelid, the most frequent surgery is the implantation of a gold weight, which helps to complete the lid closure, due to the effect of gravity.

In the lower eyelid, the most commonly used surgery to correct eyelid eversion or descent is the lateral tarsal strip.