Nocturnal Lagophthalmos

SummaryNocturnal lagophthalmos is the inability to close the eyelids during sleep. It may be physiological but can cause significant symptoms in some patients. The spectrum of the disease ranges from minimal corneal epithelial changes, which may heal later in the daytime, to corneal ulcers after severe exposure. There are a variety of predisposing factors for lagophthalmos, which can be grouped as proptosis/eye exposure etiologies, palpebral insufficiency etiologies, and idiopathic etiology. The diagnosis is easily missed in subjects having nocturnal lagophthalmos with normal voluntary lid closure (idiopathic). A diagnosis of such cases can usually be made from a detailed history and careful slit lamp examination. A focused clinical evaluation for lagophthalmos in patients complaining of redness, dryness or eye irritation, especially after sleep, will identify most cases. The optimal treatment usually depends on the cause of lagophthalmos. It may include topical agents, lid taping at night or ocular surgery to correct lid malpositioning. This article reviews the incidence, clinical presentations, etiology, diagnosis, examination, and treatments of nocturnal lagophthalmos.