Lagophthalmos: causes, symptoms, diagnosis and treatment

Lagophthalmos is a condition that prevents the complete closure of one or both eyelids. It is a problem that can be linked to more serious conditions such as facial nerve palsy, congenital malformations or injury to the orbicularis orbicularis muscle of the eye

Lagophthalmos is also common in individuals with retracting eyelid scars caused by surgery, such as blepharoplasty, or physical trauma.

Lagophthalmos: what is it?

Lagophthalmos is a condition characterised by the inability to close the eyelid rima correctly.

The eyelids perform a protective function for the eyes, especially during sleep.

During the day, their movement favours an even distribution of tears over the entire surface, ensuring the hydration of the eyes and the escape of any foreign bodies.

Among the first consequences of Lagophthalmos is dry eye, a condition that causes irritation and discomfort, exposing the eyes to dangerous infections.

In fact, incomplete closure of the eyelid rhyme leaves the cornea and conjunctiva exposed to the action of external agents, favouring corneal abrasions, keratitis and conjunctivitis.

In more severe forms of lagophthalmos, the damaged cornea shows neovascularisation and becomes opaque and may be predisposed to ulcer formation or infectious processes.

Lagophthalmos: the causes

Lagophthalmos is usually caused by a paralysis of the facial nerve, which is responsible for regulating the functioning of the eyelid muscles.

This condition can also develop in conjunction with other diseases, such as stroke.

Other causes include physical trauma, exophthalmos, i.e. protrusion of the eyeball from the orbit, and ectropion, i.e. rotation of the eyelid outwards.

Lagophthalmos is common in comatose patients with decreased orbicularis muscle tone and in persons suffering from severe skin disorders, including ichthyosis.

Sometimes lagophthalmos is a consequence of surgery.

One example is blepharoplasty, a cosmetic surgery procedure that involves removing excess skin at the eyelid level to reduce the signs of ageing.

One of the consequences of the surgery can be an incorrect alignment of the lower and upper rhyme.

More rarely, lagophthalmos affects those suffering from thyroid disorders or as a result of surgery to remove an acoustic neurinoma, a form of tumour.

Studies have shown that the condition occurs more frequently in individuals who use contact lenses, especially new ones.

Lagophthalmos: the symptoms

Lagophthalmos presents rather obvious symptoms ranging from dryness of the eyes to keratitis, to opacification of the cornea and more or less severe inflammation.

Rather than an actual disease, in medicine lagophthalmos is regarded as a consequence of other diseases.

The most common of these are herpes simplex and herpes zoster of the eye, stroke, ichthyosis, acoustic neurinoma removal surgery and Down syndrome.


Lagophthalmos is diagnosed during an eye examination.

Usually the ophthalmologist performs a slit-lamp test, inspecting the eyeball.

The patient is then asked to keep their eyes closed to measure the space between the eyelids.


After the diagnosis of lagophthalmos, treatment is possible.

The treatments that can be followed are different and vary depending on the severity of the problem.

In less severe cases, it is sufficient to apply artificial tears to keep the cornea hydrated.

The most commonly used surgical approach involves applying some plaques placed on the upper eyelid.

The force of gravity tends to push down the area, reducing the space between the rims.

If the lagophthalmos does not improve, gold plates can be implanted in the inner eyelid area by means of surgery.

The operation lasts about two hours and is performed under local anaesthesia.

However, it has some contraindications, in particular the possible occurrence of corneal astigmatism.

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