Sleeping With Your Eyes Open

Did someone tell you that you sleep with your eyes open? Chances are, you had no idea your eyes aren’t completely closed while you are asleep.

If you sleep with your eyes open, or your eyelids are only partially closed, the medical term for this is called ‘nocturnal lagopthalmos’. Since this condition is caused by a fault of the eyelid, it can also occur in the daytime too if you do not have a full blink, which is just called ‘lagopthalmos’. If you have an incomplete blink, this means that there is always a part of the eye that does not receive enough tear lubrication. Since this condition is defined by ‘the inability to close the eyelids completely’, lagopthalmos can arise with many different ocular surface and health issues.

Symptoms

Our eyelids play a vital role in maintaining the overall health of the surface of the eye. As we blink during the day and shut our eyes during the night, the eyelids cover the corneas with a thick layer of protective tear fluid. Tears help to maintain a moist environment for the cells of the eye to function properly. Therefore, when your eyelids do not fully close, your eyes are exposed to the atmosphere – causing your eyes to dry out significantly.

While the main symptom of lagophthalmos is being unable to close your eyes, if you have nocturnal lagopthalmos, you might not even know it, (unless someone has told you). Due to the inability to completely shut one’s eyes, the eye can become damaged, scratched or infected without proper lubrication. Patients with lagopthalmos will often suffer from dry eye syndrome and are vulnerable to corneal abrasions. Therefore, if you sleep with your eyes partially open or you do not have a complete blink in the daytime, the symptoms you may experience could include:

• Excessive tear production (watery eyes)
• Redness
• Blurred vision
• Burning sensation
• Light sensitivity
• Pain or irritation, especially in the morning
• Foreign body sensation (feeling like a foreign body is trapped in their eye)
• Poor quality of sleep

Why Does This Occur?

While there are a variety of causes of lagophthalmos, this condition is typically related to a problem with the muscles or nerves of the face. Anything that causes a weakness or paralysis in the muscle that closes the eyelids, called the orbicularis oculi, can lead to sleeping with eyes open and incomplete blinks. For example, lagophthalmos can be caused by conditions such as stroke, trauma, cosmetic surgery, skin conditions, facial nerve palsies, Bell’s palsy, or thyroid disease.

Physical damage to the eyelids can also be a cause of lagophthalmos. For example, eyelid surgery or scarring from burns or other injuries can damage the eyelid and make it less able to fully close.

In some cases, lagopthalmos can run in families as a hereditary condition. Less commonly, very thick upper and lower eyelashes might prevent someone from being able to fully close their eyes at night. However, for some people, sleeping with their eyes open has no obvious reason.

Children often have mild nocturnal lagophthalmos but because there tear film is usually very robust they don’t tend to be symptomatic and don’t suffer damage.

Treatment Options

Once a diagnosis has been made, treatment of lagophthalmos ranges from supportive therapy to surgery and usually depends on the cause, the severity of the condition and whether it is chronic or nocturnal in nature. For more mild cases, wearing moisture chamber goggles at night may help with moisturizing your eyes while you sleep. Also, sleeping with a humidifier on in the bedroom can also keep the surrounding air moist to help prevent the eyes from drying out. A doctor may recommend using surgical tape or an external eyelid weight, which is worn on the outside of your upper eyelids to help keep the eyelids closed during the night while you sleep.

Medications

A doctor may also prescribe medications, including:

• eye drops
• artificial tears to prevent the eyes from drying out and itching
• ophthalmic ointments to help protect the eye against corneal scratches

Surgery

In severe cases of paralysis, surgical treatment may be required. Surgical treatments options include:

• Gold weight implantation:
  • Gold weights can be implanted into the upper eyelid to treat paralytic lagophthalmos, which allows the eyes to close using gravity.
• Tarsorrhaphy:
  • If lagophthalmos is caused by a temporary condition (a temporary paralysis for example), the ophthalmologist may suggest a tarsorrhaphy. A tarsorrhaphy is a surgical procedure where the eyelids are partially sewn together to narrow the eyelid opening. Keeping the eye covered reduces the corneal exposure and evaporation of the tear film while minimising friction between the eyelid and ocular surface during blinking. This surgery helps to prevent any additional damage while you recover from the underlying condition.
  • However, if the underlying condition is going to take some time to heal, the ophthalmologist may recommend a permanent tarsorrhaphy. This means that the surgical fusion of the upper and lower eyelid margins will be performed while leaving a small opening so the patient can still see. Once the skin has healed after a few weeks, the doctor will enlarge the opening.
• Lower eyelid tightening and elevation:
  • Often a laxity of the lower eyelid occurs in conditions such as facial nerve palsy and floppy eyelid syndrome can cause lagophthalmos. In such cases, a tightening procedure such as a lateral tarsal strip can be performed to help prevent drooping and decrease tearing.

If left untreated, what are the dangers associated with sleeping with your eyes open?

If you suspect that you may have nocturnal lagophthalmos, we strongly recommend that you seek medical attention. Although lagopthalmos is typically harmless, it may lead to dry or red eyes in the morning if it is prolonged.  Extended dehydration of the eye caused lagophthalmos can lead to serious problems, such as:

• Loss of vision
• infections in the eye
• increased risk of injury or scratches in the eye
• exposure keratopathy (damage to the cornea, the outermost layer)
• corneal ulcer (an open sore on the cornea)

Do you wake up each morning with dry and sore eyes?

If you answered “yes”, this could be a sign of nocturnal lagophthalmos. If you have trouble closing your eyes to sleep or you notice that your eyes are extremely irritated throughout the day, the best course of action is to treat lagopthalmos before it becomes a more serious problem.
To find relief and to wake up feeling refreshed with comfortable eyes, book an eye exam today at Auckland Eye to speak to one of our highly specialised and knowledgeable eye care professionals. Whatever you choose to do, we highly recommend that you don’t just ignore the condition, as it could lower the quality of your sleep and affect the long-term health of your eyes.

Call 0800 25 53 93 to book your appointment and get a diagnosis and a tailored treatment plan today.