Lagoftalmos

Specialty: Ophthalmology.

• inability to close the eyelids
• eye that does not close completely
• incomplete eyelid closure

Why it occurs

• Peripheral facial palsy (Bell's palsy or idiopathic origin, most common cause of paralytic lagophthalmos)
• Retractable eyelid scars post-traumatic or after reconstructive surgery
• Moderate or severe exophthalmos secondary to active thyroid ophthalmopathy
• Late complication of upper or lower aesthetic blepharoplasty with excessive resection of skin tissue
• Tumors of the parotid gland with invasion or compression of the branches of the facial nerve (VII nerve)

Initial workup

Precise measurement in millimeters of the residual interpalpebral distance during the attempt at voluntary eyelid occlusion and during spontaneous blinking; Slit lamp examination with fluorescein staining to delineate the degree of corneal involvement (Oxford scale); Assessment of the Bell reflex (physiological elevation of the eyeball during eyelid closure); Neurological motor evaluation of the facial nerve.

Standard management

• Sodium hyaluronate 0.4% without preservatives — eye drops, apply 1 drop every hour during the day to artificially supply corneal moisture
• Ophthalmic ointment of neutral Vaseline and wool alcohols — apply liberally to the lower conjunctival sac before sleeping and every 6 hours if the closure defect is severe, providing a physical barrier against evaporation
• Mechanical occlusion of the eyelid through the nightly use of protective patches or hypoallergenic micropore tape to ensure physical eyelid closure.