Sleeping with Eyes Open (Lagophthalmos): What Is It, And Is It Bad?

What Is Lagophthalmos? 

Lagophthalmos is a medical term used to describe when a person is unable to close their eyelids completely while sleeping.¹ The condition affects one or both eyes and is common globally. According to the National Sleep Foundation, Nocturnal Lagophthalmos affects 20% of the global population.² 

However, some people aren’t even aware they have the condition. It can cause many eye and sleep-related conditions from eye irritation to dry eyes, eye pain, blurry vision, infection and more. Before discussing the causes, let’s first understand how the condition presents itself.

Lagophthalmos: What Are the Symptoms?

Lagophthalmos has many symptoms. The most notable include:³

• Watery or dry eyes
• Red eyes
• A burning or pain sensation in the eyes and/or a feeling of something stuck in the eyes
• Blurry vision
• Sensitivity to light (photophobia)
• Poor sleep
• Corneal ulcers (sores on the cornea)

What Are the Causes of Lagophthalmos?  

There are several causes of Lagophthalmos. The main causes include:³ 

1. Facial nerve damage: The facial nerve can be damaged by injury, meaning from blunt trauma, a deep cut or conditions like stroke, Bell’s palsy, tumours (like acoustic neuromas), Moebius syndrome, and autoimmune conditions like Guillain-Barre syndrome. When the nerve damage is linked to facial nerve paralysis, it causes paralytic Lagophthalmos.⁴
2. Damage to the eyelids: Injuries on the eyelids, scarring from burns and certain medical conditions like Stevens-Johnson syndrome and floppy eyelid syndrome can also cause Lagophthalmos. The same applies to eyelid damage linked to eyelid surgery, like ptosis repair and blepharoplasty.⁵ Scarring results in cicatricial lagophthalmos.
3. Natural causes & medical disorders: The condition can also occur on its own or be linked to medical disorders such as sagging eyelids or dropping eyelids linked to genetics⁶ and ageing.⁷

Ageing and Lagophthalmos

Seniors may be more susceptible to Lagophthalmos since muscles around the eyes tend to weaken as you age. Skin may also loosen, interfering with how the eyelids work. Other age-related factors include an increased risk of eye damage.⁸

Types of Lagophthalmos

There are three main types based on the underlying cause. They include:

1. Mechanical Lagophthalmos

As the name suggests, this type of Lagophthalmos occurs when the facial nerve experiences mechanical challenges and isn’t working properly. The underlying issue is normally a physical obstruction or other conditions that prevent the eyelids from closing properly, such as eyelid lift surgery procedures, scarring, floppy eyelid syndrome and conditions like thyroid eye disease.⁹

2. Nocturnal Lagophthalmos

This type is characterised by normal eye closure (when a person is awake), but the eyes remain fully or partially open when a person is asleep. The exact cause of nocturnal Lagophthalmos remains unknown. However, factors like decreasing fat tissue or variations in how someone sleeps is linked to nocturnal lagophthalmos.¹⁰

3. Paralytic Lagophthalmos

This is arguably the most common type of Lagophthalmos and is linked to facial nerve paralysis or damage. The main causes include, but aren’t limited to, stroke, Bell’s palsy, tumours, infections, trauma and autoimmune diseases like Guillain-Barré syndrome.¹¹

Diagnosing Lagophthalmos  

If you suspect you have Lagophthalmos, visit an eye care professional; this will be the first step towards a diagnosis. If you reside in Toronto or the Greater Toronto Area, visit any of the seven Kodak Lens Vision Centres for a comprehensive eye exam.

The diagnosis process includes the following:

• Answering questions on your medical history
• Physical observation of your eyes. You will be asked to perform simple actions like closing your eyes. This is meant to see how hard it is for you to do so. Your optometrist will also measure your eyelids and count how many times you blink (to assess if your eyes close completely when you do).
• You’ll also be subjected to eye tests. This could include a fluorescein eye strain test and a slit lamp exam, among other tests deemed necessary.

Lagophthalmos Treatment 

There are two main ways to treat Lagophthalmos: with a surgical and non-surgical approach.

Non-surgical Options

Non-surgical Lagophthalmos treatment options focus on dealing with the underlying causes/symptoms. The most notable non-surgical treatments include:

• Eye drops or artificial tears that deal with underlying symptoms like dry eyes.
• Ointment (for night use) also provides additional moisture.
• Special moisture goggles can also be prescribed to keep the eyes moist.
• Weights and tape to deal with the condition at night. A special tape or weights can be prescribed and applied to keep your eyelids closed at night before you start sleeping.

Surgical Options

Surgery can be recommended as a long-term/permanent approach to treating Lagophthalmos. Examples of common surgeries include:

• Tarsorrhaphy: This surgical procedure sews the eyelids partially or completely together to narrow or close the eyelid opening.
• Upper and/or lower eyelid surgeries: This can also be done to partially or completely eliminate the eyelid opening when sleeping.
• Facial surgeries: This option can also be used to restore eyelid closure and deal with other problems like corneal exposure.¹²
• Implanting platinum or gold weights: Lagophthalmos can also be treated by implanting platinum or gold weights in the eyes (upper eyelids).

Book Your Lagophthalmos Eye Check Up

In summary, Lagophthalmos is more common than most people think. As discussed, the symptoms linked to the eye condition can affect vision significantly, lowering the quality of sleep and life in general. 

To avoid such consequences, we recommend you visit renowned eye professionals near you to get a comprehensive eye exam and address your situation.

Kodak Lens Vision Centres are the best place to monitor your eye health if you reside in Toronto or the Greater Toronto Area. Schedule a Lagophthalmos eye test today. You can also call 647-952-1099 to book a comprehensive eye health exam. For more information on lagophthalmos and related conditions like exophthalmos, keratopathy, facial paralysis/facial palsy and more, speak to our experienced optometrist.

References

1. 2022, Lagophthalmos, my.clevelandclinic:
2. 2025, Signs you are sleeping with eyes open, sleepfoundation.org:
3. 2022, Lagophthalmos, my.clevelandclinic:
4. 2023, Lagophthalmos, ncbi.nlm.nih.gov:
5. 2023, Lagophthalmos, ncbi.nlm.nih.gov:
6. 2023, Ptosis, my.clevelandclinic.org:
7. 2018, Heavy Eyelids, healthline.com:
8. 2014, Aging: Predisposition to Dry Eyes, pmc.ncbi.nlm.nih.gov:
9. 2008, Lagophthalmos Evaluation & Treatment, aao.org:
10. 2022, Lagophthalmos, my.clevelandclinic.org:
11. 2019, What is Lagophthalmos? new-medical.net:
12. 2023, Lagophthalmos, ncbi.nlm.nih.gov: