Introduction
The eyes are the essential organs of the human body. Life seems complicated without any vision. Lagophthalmos is a condition affecting the closure of the eyelids that can lead to abnormal eye functioning and finally cause complications. Many types of lagophthalmos can be caused due to infections, tumors, or even trauma to the eye, and the treatment depends on the cause of the disease.
What Is Lagophthalmos?
Lagophthalmos is a condition that leads to abnormal or incomplete closure of eyelids. Closing or blinking of the eyes is necessary for the eye's health and the production of the tear film. Individuals with difficulty closing their eyes are at risk of tear film evaporation, frequent keratopathy (damage to the cornea), and corneal exposure risk.
What Are the Causes of Lagophthalmos?
The following are the causes of lagophthalmos:
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Infection - Infection of the eye is called otitis. It can be caused by viral infections such as influenza, poliovirus, herpes zoster, bacterial infections such as syphilis, tuberculosis, leprosy, botulism, and fungal infections such as mucormycosis and AIDS.
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Trauma - Birth trauma, facial injuries, skull base fractions.
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Tumor - Tumors such as teratoma, schwannoma, sarcoma, leukemia, meningioma, and carcinoma can also cause lagophthalmos.
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Metabolic Causes - Diabetes mellitus, vitamin A deficiency, hypertension, and hyperthyroidism are certain metabolic diseases that can affect the closure of eyelids.
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Toxic: Arsenic, carbon monoxide toxicity, and excess alcohol can cause lagophthalmos.
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Idiopathic Causes: Unknown causes that cannot be noticed, leading to lagophthalmos, are called idiopathic causes.
What Are the Types of Lagophthalmos?
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Paralytic Lagophthalmos: Lagophthalmos, which is caused due to paralysis of the facial nerve, is called paralytic lagophthalmos. This paralysis can be caused due to many reasons, such as infections, trauma, or even the presence of tumors in certain conditions.
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Cicatricial Lagophthalmos: Lagophthalmos caused by eyelid scarring is called a cicatricial type. Eyelids have seven layers, and scarring can occur due to injury to any of the seven layers. This injury causes a lack of eyelid closure. Broadly, cicatricial lagophthalmos can be caused by Chemical burns, trauma, and solar elastosis.
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Nocturnal Lagophthalmos: Nocturnal lagophthalmos usually occurs during sleep and can show symptoms like exposure to keratopathy and dry eyes.
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Incomplete Blink and Lagophthalmos: An incomplete blink followed by lagophthalmos can be caused by conditions like Parkinson's disease, myotonic dystrophy, and ophthalmoplegia.
What Is Meant by Paralysis of the Eye?
Ophthalmoplegia is known as paralysis of the eye. This condition can affect one or more muscles of the eyes, which hold the eye in position and monitor the movement of the eyes. Eye paralysis is of two types.
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Chronic progressive external ophthalmoplegia.
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Internal ophthalmoplegia.
What Is the Diagnosis of Lagophthalmos?
Diagnosis of lagophthalmos can be made by proper clinical examination:
Signs and symptoms include:
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Exophthalmos.
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Bell's phenomenon.
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Eyelid malposition.
A few tests listed below are also conducted.
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Spacing between the eyelids when the patient is asked to close their eyes.
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Cranial nerve function examination.
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Cornea sensitivity test.
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Computed tomography orbital imaging.
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Magnetic resonance neuroimaging.
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Thyroid function tests.
What Are the Management Approaches for Lagophthalmos?
Medical and surgical approaches are both used in the management of lagophthalmos.
Medical Approach:
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Artificial tears are used to administer to improve the tear film.
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No preservatives are used in artificial tears.
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The ointment is applied once a day when there is severe corneal exposure.
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Moisture chamber-type glasses, which help stabilize the tear film, are also used.
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The hyaluronic acid gel is used to expand tissue in the immediate management of cicatricial lagophthalmos.
Surgical Management of Lagophthalmos:
The following are the various surgical procedures followed.
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Tarsorrhaphy: Temporary tarsorrhaphy is the best choice for recovery within a few weeks. The lateral one-third of the eye closure is often done to protect the cornea. A small portion of the eye remains open to assess the corneal opening, Followed by topical application of the medications. With time, the sutures can be loosened, which results in a lack of complete ocular protection. Complications such as poor cosmesis and trichiasis can occur from scarring.
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Gold/Platinum Weight Implantation: Implantation of the gold or platinum weight is done in cases without complete eye closure. This treats paralytic lagophthalmos and is implanted in the upper eyelid. The closure is based on gravity due to the weight of the implanted material. At first, gold was used, and later on, platinum was used as it is more advantageous than gold and has fewer chances of inducing an inflammatory reaction. The weight of the implant material should be such that it will allow both full lid closure and the opening of the eyelids.
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Upper Eyelid Retraction and Levator Recession: Patients with lagophthalmos from thyroid disease undergo recessive surgery. The surgery is done on the muscles of the upper eyelid. There can be eyelid shortening after the surgery; advancement flaps or full-thickness skin grafts are the options in such cases.
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Lower Eyelid Tightening and Elevation: In patients with facial nerve paralysis, the lower eyelid has laxity. The lateral tarsal strip is a lid-tightening procedure that improves the apposition of the lower eyelid. Lower eyelid elevation can be done with retractor muscle recession in cases that relapse after medical or surgical therapy—ancillary surgical procedures.
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Midface Elevation: This procedure is done in individuals with severe lagophthalmos with facial nerve paralysis. Other surgical procedures included nerve grafts, palpebral springs, soft tissue repositioning, and temporalis muscle transposition.
What Are the Complications of Lagophthalmos?
Mild complications include the following.
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Dry eyes.
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Corneal abrasions.
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Ulceration.
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Epithelial defects.
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Corneal scarring.
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Microbial keratitis.
In severe cases, corneal perforation leading to vision loss can also occur.
What is the Prognosis of Lagophthalmos?
Depending on the cause of the condition, prognosis varies. Mild keratopathy is said to have a good prognosis. In cases of lagophthalmos due to Bell's palsy, patients mostly show resolution in a limited time. Severe cases can have poor prognoses, resulting even in vision loss.
Conclusion
Lagophthalmos is a condition that can present along with an underlying condition or can occur due to defects or trauma causing difficulty in the closure of the eyes. It can be treated either medically or surgically. Delay in diagnosis or detection of the disease can make it severe, worsening the prognosis and causing certain complications like vision loss. Hence, appropriate precautions are to be taken to avoid more burdensome consequences by consulting an ophthalmologist.
