Lagoftalmos: Causes, Symptoms and Treatment Options for a Non-Closing Eyelid
What is lagophtalmos?
Lagoftalmos is a condition in which the eyelid does not close completely, which can lead to dehydration, irritation and damage to the surface of the eye. This occurs because the eye's natural protective mechanisms, such as hydration and shielding against external influences, do not function adequately. Lagoftalmos can occur in one or both eyes and varies in severity.
Causes of Lagoftalmos
This condition can have several causes, including:
- Neurological damage: Conditions such as Bell's palsy or facial nerve damage can cause the eyelid to not move adequately.
- Scarring or trauma: Skin tightening due to scarring on the eyelid can affect closing function.
- Cosmetic surgery: Excessive skin removal during eyelid surgery (blepharoplasty) can result in incomplete eye closure.
- Congenital anomalies: In some cases, lagophthalmos is present from birth.
Symptoms of logophthalmos
Lagoftalmos can cause a range of symptoms that vary in severity depending on the degree to which the eye does not close completely. Because the surface of the eye is inadequately protected and moistened, several symptoms may occur:
1. Dry, irritated and red eyes.
When the eyelids do not close completely, the tear fluid evaporates faster than normal. This leads to dry eyes, a tingling sensation and redness. Especially during sleep, when the eyes are not moistened for long periods of time, this problem can worsen.
2. Excessive tears in response to dehydration
The body responds to dehydration of the cornea by producing extra tears. This may seem paradoxical, as people with lagophthalmos often suffer from both dry eyes and excessive tears. However, tear production is not sufficient to fully compensate for dehydration, leaving the surface of the eye vulnerable.
3. Sensitivity to light (photophobia).
Because the protective layer of tear fluid is not optimal, the eye may become more sensitive to bright light. Sunlight, computer screens and artificial light can cause discomfort, leading to a tendency to squeeze the eyes together or blink extra.
4. Eye infections and corneal damage (keratopathy).
Inn severe cases, prolonged exposure of the cornea can lead to:
- Irritation and inflammation as dust, bacteria and dry air are given free rein.
- Corneal damage (expository keratopathy), in which small wounds or ulcers form on the cornea, which can affect vision.
- Eye infections, such as conjunctivitis or keratitis, which can occur as a result of disrupted tear film and reduced natural protection against pathogens.
Personalized advice from our eyelid surgeons
Our highly specialized surgeons do a thorough diagnosis and analysis of your eyes. They will discuss all options with you in complete objectivity.
Medical treatment of lagophthalmos
Medical treatment options for Lagoftalmos
The choice of treatment depends on the severity of the condition and the underlying cause. The goal of treatment is to prevent dehydration of the eye, reduce irritation and prevent complications such as corneal damage.
1. Conservative treatment for mild cases
In mild forms of lagophthalmos, where the eye remains only partially open, noninvasive treatments can help keep the eye surface hydrated and protected:
- Artificial tears and eye ointments: Regular use of moisturizing eye drops during the day and an eye ointment at night can help protect the cornea from drying out and irritation.
- Sleep masks or eye closures: During sleep, special eye dressings or a moist room environment can help reduce evaporation of tear fluid.
- Protective contact lenses: In some cases, special therapeutic contact lenses can protect and moisturize the surface of the eye.
Surgical treatment of Lagoftalmos
Surgical treatment for severe lagophthalmos
When conservative treatments do not help sufficiently, surgery may be necessary. The choice depends on the cause and severity of the condition:
- Implantation of a gold or platinum weight:
A common technique for facial palsy (such as Bell's palsy). The weight in the upper eyelid helps the eye close naturally and preserves eyelid function.
- Eyelid reconstruction or canthoplasty:
Strengthening of the eyelid muscles or correction of eyelid position. A canthoplasty provides a better fit of the lower eyelid to the eye.
- Tissue or skin grafting:
Scarring or previous surgery may require a skin or tissue graft to rebuild the eyelid and restore closure function.
Aftercare and recovery
- Eye drops and ointments often remain necessary.
- Swelling and bruising usually disappear within a few weeks.
- Regular follow-up with the ophthalmologist is essential.
With proper treatment, eye function improves significantly, providing more comfortable and healthier vision.
Course of operation of lagophtalmos
Pre-operative screening for the treatment of lagophthalmos
Careful pre-operative screening is essential for successful treatment of lagophthalmos. During this consultation, the ophthalmic surgeon assesses the patient's general health status, as well as the specific anatomy and functionality of the eyelids. Factors such as the degree of incomplete eye closure, muscle function, skin excess, scarring and any underlying conditions are thoroughly evaluated to create an optimal treatment plan.
In addition, during the consultation, the procedure is explained in detail, including treatment options, potential risks and the expected postoperative recovery process. If necessary, additional diagnostic testing, such as a vision test or tear film analysis, may be performed to better assess the impact of the condition on the ocular surface.
Proper preparation contributes to optimal functional and aesthetic results and minimizes postoperative complications. This ensures that the procedure is not only effective, but also as comfortable as possible for the patient.
Preparation and procedure in the treatment of lagophthalmos
Preoperative prescriptions.
In order for the procedure to be safe and effective, it is important to follow the following guidelines:
- Blood thinners: If you are taking blood-thinning medication, you should stop it in consultation with your doctor at least 7 days before surgery.
- Transportation: On the day of surgery, you may not drive yourself. Make sure you have an escort or use private transportation. Public transportation is not recommended.
- General health: Make sure your eyelid region is free of makeup, creams or other products on the day of surgery.
Anesthesia
The procedure is usually performed under local anesthesia, possibly combined with a mild sedative medication to increase comfort during the procedure.
The surgical procedure
The choice of technique depends on the severity and cause of the condition. Possible corrections include:
- Reconstruction of the eyelid: If necessary, a small amount of skin is removed to make the eyelid close better. This is done through a carefully outlined pattern so that the scar is barely visible.
- Eyelid strengthening: The tarsus of the lower eyelid (the firm connective tissue) is strengthened and correctly sutured to the temporal canthus (the outer corner of the eye). This improves the natural closure of the eyelid.
Depending on the individual situation, additional corrections can be performed to optimize the function and aesthetics of the eyelid.
Aftercare and Recovery After Lagoftalmos Treatment
Smooth recovery and optimal results after lagoftalmos treatment require careful aftercare. We recommend strict adherence to the guidelines below:
General guidelines
- Avoid bending forward (for example, when tying shoes) and avoid lying completely flat. Sleep on your back with an extra pillow to minimize swelling.
- Limit physical exertion and busy environments to maintain stable blood pressure and prevent excessive swelling.
- Activities such as reading and watching television are allowed and do not affect the recovery process.
Postoperative care
- Eye cooling: Use a cold compress or a moistened, clean washcloth to reduce swelling. Avoid direct contact with ice or cold packs to prevent frostbite damage to the skin.
- Medication: Prescribed anti-inflammatories and analgesics should be taken according to the treatment plan.
- Eye care: Apply artificial tears for one week to keep the eye surface hydrated and an antibiotic ointment on the scar to prevent infection.
Follow-up and monitoring.
- Sutures are removed after approximately one week, unless otherwise advised by the treating physician.
- Schedule a checkup appointment in a timely manner to have the healing and functional recovery of the eyelids evaluated.
By carefully following these guidelines, you will contribute to an optimal recovery and prevent possible complications.
Our eyelid surgeons
Dr. Philippe Greant
Dr. Philippe Gréant is an experienced plastic and aesthetic surgeon with more than 30 years of practical experience. After 13 years of training at the University Hospitals of Brussels, he obtained his legal accreditation in plastic-aesthetic surgery. He also took additional training courses in France and the United Kingdom.
During his career, Dr. Gréant has developed a broad expertise in various techniques within plastic surgery, ranging from microsurgery and hand surgery to general plastic and aesthetic surgery. Today, he focuses primarily on aesthetic facial surgery, applying advanced techniques to achieve natural results.
Dr. Gréant is a member of the Belgian Society of Plastic Surgery and the American Society of Plastic Surgery. In addition, he is a medical expert and sponsor of the Plastic Surgery Foundation. He also participates in humanitarian missions.
Dr. Karel Goyvaerts
Dr. Karel Goyvaerts is an experienced and dedicated ophthalmologist trained at the University of Antwerp. With a strong scientific background and years of practical experience, he is committed to providing patients with the best possible eye care. His analytical precision and patient-centered approach ensure that each treatment is precisely tailored to the individual needs of his patients. At Focus Eye Clinic, Dr. Goyvaerts strives to make complex eye problems clear and accessible. His friendly and professional approach makes him a trusted physician for patients from diverse backgrounds. His bilingualism in Dutch and French allows him to put a wide range of patients at ease. Dr. Goyvaerts continues to continually study the latest developments in ophthalmology and is a valued member of our team.
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