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Unable to Blink Eyelids

unable-to-blink-eyelids

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By Medicover Hospitals / 12 Jan 2021
Home | symptoms | unable-to-blink-eyelids
  • When the skin feels warm to the touch, it often means that the body temperature is higher than normal. This can occur because of infection or illness, but it can also be caused by an environmental situation that increases body temperature.
  • Article Context:

    1. What can’t we blink eyelids?
    2. Causes
    3. Diagnosis
    4. Treatment
    5. When to visit a Doctor?
    6. Prevention
    7. FAQ's
  • Lagophthalmos is a condition that prevents the eyes from closing completely. If the problem only occurs when you sleep, it's called nocturnal lagophthalmos. The condition itself is usually harmless but leaves the eyes vulnerable to damage.
  • The space between the upper and lower lids exposes the ocular surface, causing dryness problems that can aggravate and threaten the integrity of the eye and the quality of vision.
  • Not being able to blink results in:
    • Greater evaporation of tears
    • Poor distribution of the tear film
    • Disruption of the mucin layer component of the tear film
    • Drying of the cornea
    • Rupture of the ocular surface

    Causes:

  • Orbicularis muscle function failure of the eyelids. This is the most common cause. It can be paralytic, because the facial intracranial nerve affects the orbicularis oculi muscle, or spastic, as seen in thyrotoxicosis.
  • The excessive bulge of the globe in orbit. Lagophthalmos can accompany proptosis or buphthalmos (enlarged cornea because of elevated intraocular pressure in young children), although the eyelids are normal, not covering the proposed eye.
  • The inadequate vertical dimension of the upper or lower eyelid. It can be structural when the retraction or shortening of the eyelids is because of scarring or atrophy after injury or disease. Babies with a collodion membrane may have temporary lagophthalmos because of the restrictive effect of the membrane on the eyelids.
  • Other causes can be:
    • injury, either from blunt trauma or deep cut
    • stroke
    • tumors, especially acoustic neuromas
    • moebius syndrome
    • autoimmune conditions, such as Guillain-Barré syndrome
    • scars from burns, injuries, or certain medical conditions
    • eyelid surgery
    • floppy eyelid syndrome

    Diagnosis:

  • Using your medical history and a physical exam, your doctor will try to discover the underlying cause of the lagophthalmos. Be sure to tell your doctor about any recent injuries or infections that you are not aware of.
  • Your doctor will probably run some tests as well. You may be asked to look down while trying to close your eyes. Your doctor will measure the space between your eyelids with a ruler. They can also record how often you blink and how much your eyes close when you blink. The amount of force you used to close your eyes can also help your doctor determine if the facial nerve is involved.
  • A slit-lamp examination by an ophthalmologist may show interpalpebral punctate epithelial keratopathy, which is a diagnosis of lagophthalmos or incomplete blinking. The distribution of punctate epithelial keratopathy depends on the position of the cornea during sleep in patients with nocturnal lagophthalmos.
  • The external examination for complete closure of the eyelids should be performed with the patient gently closing the eyes.
  • The function of the levator muscle of the superior eyelid (during the eyelid excursion from top to bottom) should be measured in all patients with suspected lagophthalmos. Patients with inadequate mobility of the upper eyelid retractors may have lagophthalmos despite a normal amount of vertical skin.
  • Acute dysfunction of the seventh intracranial nerve, because of Bell's palsy, trauma, or iatrogenic injury, can cause lagophthalmos. In cases with subtle weakness of the orbicularis oculi muscle, manual distraction of the eyelids during forced closure can expose a weakness that can lead to nocturnal lagophthalmos or incomplete blinking.
  • Your doctor may also perform a fluorescein eye stain test to see if there are signs of damage to the eye.
  • Treatment:

    Non-surgical treatment:

  • Non-surgical treatment options focus on treating the symptoms of lagophthalmos, rather than the condition itself. Applying artificial tears (Visine Pure Tears, Refresh) during the day can help prevent your eyes from becoming dry and itchy. You can also apply a protective ointment on the cornea throughout the day to avoid scratches.
  • If you have nocturnal lagophthalmos, moisture goggles can help protect and hydrate your eyes while you sleep. You can also keep a humidifier nearby while you sleep for added humidity. Your doctor may suggest that you place small weights on the outside of your eyelids to keep them closed. A surgical tape can provide the same effect.
  • Surgical treatment:

  • Surgical treatment depends on an accurate diagnosis of the underlying cause of the lagophthalmos.
  • Proptosis:

  • Patients with proptosis are usually best managed by orbital decompression and repositioning of the eyeball within the orbit. Patients who cannot decompress may benefit from eyelid lengthening procedures to reposition the eyelids anterior to the corneal apex during eye closure. Patients with a retrobulbar mass or hemorrhage require removal or drainage of the retrobulbar lesion.
  • Cap shortening:

  • Lagophthalmos because of iatrogenic trauma or shortening of the upper eyelids often requires reconstructive soft tissue surgery.
  • Inadequate vertical skin:

  • Lagophthalmos because of inadequate vertical skin requires replacement with flaps or skin grafts.
  • Symblepharon:

  • The lagophthalmos because of the palpebral-balloon adhesion by symblepharon is treated by releasing the symblepharon and rebuilding the appropriate cul-de-sac (junction between the palpebral and bulbar conjunctiva) with a mucous membrane graft.
  • Paralysis of the orbicularis oculi muscle:

  • Measures to reduce evaporation and increase lubrication may be sufficient with anticipated short-term limited exposure keratopathy. If the exposure is severe or expected to be long-lasting, tarsorrhaphy may be performed.
  • Lower eyelid retraction:

  • Patients with paralytic laxity of the lower eyelid and ectropion are best treated by placing a spacer to elevate and support the eyelid. The spacer material may be donor sclera or fascia, autogenous nasal or atrial cartilage, acellular human dermis, or hard palate mucosa. The mucosa of the hard palate has become increasingly common for the relief of retraction of the lower eyelid.
  • Complications with the closed eyelid:

  • Untreated lagophthalmos leaves the eyes vulnerable to scratches and other injuries because they are not protected by the eyelids.
  • Continuous eye exposure can also lead to exposure keratopathy, which has the same symptoms as lagophthalmos. Exposure keratopathy can eventually cause the cornea, the clear front part of the eye, to swell or become thin. It can also lead to a corneal ulcer.
  • Surgery to treat lagophthalmos can also have complications. Cartography can leave permanent scars, while gold-weight implants can begin to move away from their original location. Be sure to follow your doctor's post-surgery instructions to avoid additional problems.
  • Prevention:

  • Lagophthalmos cannot be prevented unless it results from retraction of the eyelid after blepharoplasty surgery through the skin or other surgical scars. In principle, it is important to detect it, to establish if it poses any risk to vision or to the eye, and to take the necessary measures to treat it.
  • Frequently Asked Questions:

  • Facial nerve paralysis (paralytic lagophthalmos) is the primary cause of lagophthalmos but also happens during trauma or surgery (cicatricial lagophthalmos) or during sleep (nocturnal lagophthalmos).
  • It can be inherited, so if you sleep with your eyes open, your baby might as well (but most kids outgrow it when they get older). However, if you still experience nocturnal lagophthalmos in adulthood, it is important to see a doctor.
  • Your doctor may prescribe you eye drops and ointments if you have nocturnal lagophthalmos, which protect your eyes from drying out.
  • Citations:

  • Science Direct - https://www.sciencedirect.com/science/article/abs/pii/S138824570400416X
  • MDPI - https://www.mdpi.com/2076-2615/9/8/562
  • Online Library - https://movementdisorders.onlinelibrary.wiley.com/doi/abs/10.1002/mds.870090404