Lagophthalmos is the term for an incomplete lid closure of the eye. Sometimes the symptom leads to a widening of the lid gap.
What is lagophthalmos?
In some cases, however, lagophthalmos is caused by scars that result in a shortening of the eyelids.
Lagophthalmos is an incomplete closure of the eyelid. The symptoms fall into the field of ophthalmology and neurology. In some cases, lagophthalmos can cause the eyelid gap to widen. See AbbreviationFinder for abbreviations related to Lagophthalmos.
The term lagophthalmos comes from the Greek and means in German translation “rabbit eye”. Lagos means “hare” while Ophthalmus means “eye”. In most cases, lagophthalmos is only seen in one eye. But 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 (sore formation) and loss of the affected eye.
Causes
The causes of lagophthalmos are different. The most common reason for the eye disease is a peripheral paralysis of the facial nerve, which forms the 7th cranial nerve. In medicine, this is then referred to as a facial paralysis. This affects the orbicularis oculi eye muscle, which has the shape of a ring. A possible origin of the paresis can be a stroke.
In some cases, lagophthalmos is also caused by scars that result in a shortening of the eyelids. The same applies to the 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 are ectropion (deformity of the eye), congenital malformations such as a coloboma, an endocrine orbitopathy that occurs in Graves ‘ disease, zoster oticus, polyneuritis, meningitis, a cerebellopontine angle tumor or the occurrence of a coma. In rare cases, leprosy on the eyelids also leads to a so-called rabbit eye.
Symptoms, Ailments & Signs
People with lagophthalmos feel as if they have a foreign body in their eye. In addition, there is a burning sensation in the eyes, which is often perceived as tormenting. In addition, the eye feels dry. The reason for this is the inability of the eye muscle to completely close the eye.
It is not uncommon for lagophthalmos to dry out the cornea, which doctors refer to as xerophthalmia. There is a risk that the cornea will become inflamed and an ulcer will form. If the patient tries to close the affected eye, Bell’s phenomenon appears.
This is a temporary upward rotation of the eyeball. Because lagophthalmos also reduces blinking, this leads to impaired tear drainage and tear dripping. If there is a mild form of lagophthalmos, there is sometimes a positive eyelash sign.
Diagnosis & course of disease
If there is a suspicion of lagophthalmos, it is recommended to consult an ophthalmologist, as well as a neurologist. The neurologist clarifies whether the symptoms are caused by paralysis of the facial nerve. At the ophthalmologist, a thorough examination of the affected eye takes place with a slit lamp.
In this procedure, the ophthalmologist checks the conjunctiva, the cornea and the inside of the eye for possible damage. With timely treatment, lagophthalmos takes a favorable course. Without appropriate therapy, however, there is a risk of complications such as a corneal ulcer. In a very unfavorable course, it can even lead to the loss of the eye.
Complications
In most cases, lagophthalmos leads to a relatively strong foreign body sensation in the patient’s eye. As a result, those affected often suffer from a burning sensation directly in the eye or from very dry eyes. The eye pain can also spread to other regions and continue to lead to headaches. The quality of life of those affected is significantly reduced by lagophthalmos.
Likewise, lagophthalmos can lead to impaired concentration and coordination in the patient. The field of vision of those affected is often limited and an ulcer can form. Inflammation of the cornea can also occur, which must be treated by a doctor in any case. In most cases, lagophthalmos does not heal itself, so that a doctor must be consulted in any case.
Treatment of this disease in most cases is carried out with the help of various ointments and eye drops. There are no complications. In serious cases, however, surgical interventions or the use of antibiotics are necessary. There are no complications here either. The life expectancy of the patient is usually not reduced by lagophthalmos.
When should you go to the doctor?
If there is a foreign body sensation in the eye, a doctor should be consulted to clarify the cause. If the eyelid cannot be closed completely, it is advisable if this observation is discussed with a doctor. If small particles from the immediate vicinity repeatedly get into the eye despite blinking strongly, a doctor’s visit is required. If you experience dry eyes or watery eyes, you should consult a doctor. Pain in the eye, itching, discomfort and changes in vision need to be evaluated and treated by a doctor. Eye muscle disorders are a red flag that should be followed up.
If the symptoms cause friction in the eye and reddening as a result, the person concerned needs medical help. A doctor should be consulted in the event of inflammation in the area of the eyes, irritation or inner restlessness. If the person concerned suffers from insomnia, headaches or swelling of the eyes, a doctor must be consulted as soon as possible. Changes in blinking, ulceration, and retinal discoloration should be promptly evaluated and treated. If tear drainage is impaired or pus forms, a doctor’s visit is advisable. The affected person must expect an increase in symptoms without medical care.
Treatment & Therapy
The treatment of lagophthalmos depends on the extent of damage to the cornea. An important role in the treatment of the disease is played by adequate moistening of the surface of the eye. An eye ointment or eye gel can be used for this purpose. In some cases, a special watch glass bandage is also used.
This is a transparent Plexiglas flap fitted with a band-aid covering it. The watch glass bandage protects the cornea from external influences and drying out. Soft contact lenses are a further protective measure against drying out.
In the case of reversible forms of lagophthalmos, lead weights have also been applied to the upper eyelid since 1993. Due to their more efficient functional effect and their better cosmetics, they are superior to the watch glass bandage and ensure that the patient remains fit to drive. In addition, eye drops can still be applied.
If the conservative treatment methods do not lead to an improvement and the paralysis does not recede, an operation must be carried out. The same applies if major damage to the eye occurs. During the operation, the upper and lower eyelids are partially closed. The patient is given a local anesthetic before the procedure. The row of eyelashes is usually retained with this procedure.
The procedure allows for surgical reopening. In the case of irreversible forms of lagophthalmos, it is also possible to permanently implant a metal weight in the upper eyelid, which ensures that the eye is closed. This is especially true after an acoustic neuroma or a parotid tumor.
This method was used as early as the 1950s, but was then temporarily forgotten until it was used again in German eye clinics in 1990. If there is already inflammation of the cornea (keratitis) or an ulcer, antibiotics are used to treat it.
Outlook & Forecast
The prognosis of lagophthalmos is favorable. Nevertheless, cooperation with a doctor is required, since there is no spontaneous healing and the possibilities of self-help are not sufficient. Without treatment, an increase in symptoms is to be expected. The field of vision is further restricted, paralysis increases in extent and vision is impaired overall. This increases the general risk of accidents in everyday life and the well-being of those affected 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 a good tolerability of the preparations is certified. In rare cases, surgery is required to improve healing. If this proceeds without further complications, freedom from symptoms can be documented after the wound healing process is complete.
The eyelid opening is surgically restored and the functionality of the eye is thus corrected. If the surrounding areas are damaged during the intervention, the extent must be taken into account when making an overall prognosis. If there is pus formation in the eye area, the risk of sepsis is increased. This is a potential threat to human life. Intensive medical care is necessary, otherwise premature death may occur.
Prevention
In order to prevent lagophthalmos, the triggering underlying diseases must be prevented. However, this is not possible with a facial paralysis or malformation.
Aftercare
In most cases, patients with lagophthalmos have little or no special follow-up care available. Here, the patient should see a doctor early on, so that there are no further complications and no further worsening of the symptoms. As a rule, lagophthalmos cannot heal itself, so ideally the patient should consult a doctor as soon as the first symptoms and signs of the disease appear.
As a rule, the disease can be well alleviated even with a minor surgical intervention. After such an operation, those affected 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.
Contact lenses can also significantly alleviate the symptoms of lagophthalmos, so those affected should wear them if they have been prescribed by a doctor. If lagophthalmos occurs due to 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 tumor from spreading. As a rule, however, this disease does not reduce the life expectancy of the person affected.
You can do that yourself
Patients suffering from lagophthalmos usually feel severe pain in the area of the affected eye. The most important self-help measure is therefore to carefully care for the eye and protect it from further irritation. This can be done, for example, with the help of a sleep mask that the patient can wear at night.
The doctor will also prescribe special eye ointments for the patient . These need to be applied regularly, and sometimes they can be supplemented with natural remedies. After consultation with the doctor, for example, the remedy arnica can be used, which relieves inflammation and pain.
Rest and bed rest apply in the case of an operative intervention. The patient should not subject the eye to any additional stress after the procedure and should also take care of the body in order to reduce the risk of secondary infections. The medicines prescribed by the doctor must be taken at the same time. It is a good idea to write down any side effects or interactions and let the doctor know about them. In this way, the medication can be optimally adjusted to the needs of the person concerned. In general, if you have pronounced lagophthalmos, you should see a doctor regularly.