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Lagophthalmos: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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[ What causes lagophthalmos?
Causes of lagophthalmos include facial nerve damage, retraction, eyelid scars, exophthalmos, and symblepharon. Facial nerve damage may be congenital, idiopathic (Bell's palsy), or develop as a result of hypothermia, ear disease, meningitis, HIV infection, and other diseases. Lagophthalmos is sometimes also caused by congenital shortness of the eyelids, but more often it depends on cicatricial processes on the skin of the face and eyelids and is often caused by significant protrusion of the eyeball (exophthalmos); this is observed when a tumor grows behind the eye and with other orbital processes.
How does lagophthalmos manifest itself?
Objectively, the palpebral fissure on the affected side is noticeably wider, the lower eyelid is lowered and lags behind the eyeball. Due to the eversion of the lower eyelid and the lacrimal point, lacrimation occurs. Due to the failure of the eyelids to close, the eye is open during sleep. Permanent or temporary lagophthalmos leads to the development of dry eye, corneal dystrophy, keratitis, and corneal ulcers occur.
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How is lagophthalmos treated?
Treatment of lagophthalmos depends on the cause of lagophthalmos. In case of facial nerve paralysis, treatment is carried out by a neurologist under constant supervision of an ophthalmologist. Local treatment at the initial stage is aimed at moisturizing the cornea (artificial tears, 20% sodium sulfacyl solution, sea buckthorn oil, antibiotic ointments, especially at night) and reducing lacrimation (the eyelid is temporarily pulled up with a plaster). Lateral and medial suturing of the eyelids is performed during the treatment of both temporary and persistent lagophthalmos to avoid damage to the cornea. For the purpose of functional rehabilitation, gold implants are inserted into the upper eyelid, and horizontal shortening of the lower eyelid is performed to pull it up to the eyeball.
It is possible to perform surgical restorative operations - lateral and medial suturing of the eyelids is performed during the treatment (both with temporary and persistent lagophthalmos) to avoid damage to the cornea, creating temporary ptosis. For the purpose of functional rehabilitation, gold implants are inserted into the upper eyelid, and horizontal shortening of the lower eyelid is also performed to pull it toward the eyeball.
It is recommended to use soft contact lenses as protective dressings. It is necessary to treat facial paresis, eversion of the eyelids, and also to eliminate the causes that caused exophthalmos.
The prognosis is generally favorable, but in the presence of a corneal ulcer it worsens significantly.