Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Why Do We Close Our Eyes During Sleep? | Causes of Nocturnal Lagophthalmos | Symptoms of Nocturnal Lagophthalmos | Diagnosis of Nocturnal Lagophthallmos | Treatment of Nocturnal Lagophthalmos
Overview
For most people, falling asleep involves closing their eyes and assuming a peaceful repose.
As a result, it may come as a surprise to realize that some people find it difficult or impossible to close their eyes while sleeping, a condition known as nocturnal lagophthalmos.
Experts believe nocturnal lagophthalmos is not such a rare condition. Studies indicate that about five percent (5%) of the population experience this disorder.[1]
Considering that nocturnal lagophthalmos can substantially impact eye and sleep health, it’s essential to understand its causes, symptoms, and treatment options. Let us get started.
Why Do We Close Our Eyes During Sleep?
Our eyelids are essential for a good night’s sleep and safeguarding our eyes from injury.
When we close our eyes during sleep, the eyelids block out light, vital for regulating the body’s intrinsic 24-hour clock.
Typically, when light gets into the eyes, particular retinal cells process the light and transmit data to the hypothalamus, which keeps us awake or tells us to get up from sleep.[2]
So, the eyelids help interrupt this process so our bodies can prepare for sleep. Also, the body secretes melatonin (the sleep hormone melatonin) in response to darkness when we shut our eyes.[3]
Aside from being crucial to initiating the sleep process, the eyelids also keep our eyes from harm.
Picture if we left our eyes open while we slept. Things could get in without us realizing it. So, the eyelids shield the eyes from foreign objects. They also lubricate the eyes and keep them from drying out.
Causes of Nocturnal Lagophthalmos
There are many possible causes of nocturnal lagophthalmos. However, the most prevalent causes include facial nerve problems, malfunctioning eyelid mechanics, and structural alterations in the face.
Many other conditions can make a person develop the above-mentioned problems, putting them at risk of nocturnal lagophthalmos.[3] Some of them include:
- Nerve Palsies: Any damage to the nerves of the face, particularly the facial nerve, can cause the eyelids to malfunction. Some ailments that can harm the facial nerve include stroke, Bell’s palsy, Lyme disease, etc.
- Weak and Short Eyelids: When the eyelids are too short or have too little tone, they can’t close completely. Short and weak eyelids can result from medical treatments like surgery to tighten the eyelids and Botox injections.
- Proptosis: A condition where the eyeballs bulge out from their sockets. When the eyeball bulges, the eyelids have to cover more surface area. Thyroid problems, congenital conditions altering the structure of the face, infection, or tumors are all possible causes of proptosis.
- Medications: Some drugs can affect the functioning of the eyelids and muscles of the face, causing nocturnal lagophthalmos. Some implicated drugs include sedatives and alcohol.
It’s vital to note that the exact cause of nocturnal lagophthalmos can not be identified in some cases. In this scenario, experts refer to the condition as idiopathic nocturnal lagophthalmos.
Also, sleepwalkers usually keep their eyes open during sleepwalking bouts. However, it is considered a different condition from nocturnal lagophthalmos.[4]
Symptoms of Nocturnal Lagophthalmos
Individuals with nocturnal lagophthalmos may experience these symptoms. They include:
- Watery or dry eye
- Eye pain
- Blurry vision
- Red eye
- A sensation that something is stuck in your eye
- Sensitivity to light.
Many studies indicate that persons who experience nocturnal lagophthalmos may also report insomnia or poor sleep quality.[5] Experts believe this results from light entering through open eyelids, causing sleepers to awaken from visual stimulation.
How Is Nocturnal Lagophthalmos Diagnosed?
An examination of the eyes is the primary step in diagnosing nocturnal lagophthalmos. Before that, your doctor will extensively review your symptoms, risk factors, and medical history.
After reviewing your concerns, symptoms, and physical examination findings, your doctor may suggest a slit-lamp eye examination. This eye investigation examines structures within the eye using a low-powered microscope.
After your doctor has confirmed a lagophthalmos diagnosis, a treatment plan that best suits you will be developed.
Treatment Options
There are several effective treatment options for nocturnal lagophthalmos.
Your doctor’s treatment depends on the condition’s cause and severity. If your physician identifies a specific cause, a treatment plan will be prescribed to resolve the underlying condition.
In most cases, the primary goal of treating nocturnal lagophthalmos is to alleviate dry eye and prevent keratitis and possibly blindness.[6]
If you have dry eyes, your doctor may prescribe an eye drop (artificial tears) for use during waking hours and bedtime.
In more challenging situations, your doctor may advise using special tape to keep the eyelids closed at night or a goggle-like device that gives moisture while sleeping.
Here are some things you can do at home to improve your sleep if you have nocturnal lagophthalmos:
- Optimize Space for Sleep: If you have nocturnal lagophthalmos, you may need to switch up your sleeping environment to offset its effects. Keep the room as dark as possible. Also, dry eye can be reduced by shifting your bed away from dry airflow or using a humidifier.
- Blinking Helps: People who suffer from nocturnal lagophthalmos may find it beneficial to practice blinking more regularly during the day to keep their eyes wet.[7]
- Stay away from Implicated Medications: Sedatives and alcohol can cause and worsen the symptoms of nocturnal lagophthalmos. Avoiding these medications can improve your symptoms significantly.
It’s important to note that some cases require surgery. Your doctor may use these techniques during surgery, including stitching the eyelids closer together, implanting microscopic gold weights in the eyelids, etc.
Although these treatments may appear serious, they are safe and effective.
When Should I Contact My Doctor?
Nocturnal lagophthalmos can be challenging to figure out on your own. Suppose you have persistent eye symptoms, especially dry eyes that worsen in the morning.
In that case, you should contact a doctor as soon as possible. If untreated, nocturnal lagophthalmos can harm your eye health and disrupt your sleep.
References:
- Latkany, R. L., Lock, B., & Speaker, M. (2006). Nocturnal lagophthalmos: an overview and classification. The ocular surface, 4(1), 44–53. https://doi.org/10.1016/s1542-0124(12)70263-x
- Brain basics: Understanding sleep. (n.d.). National Institute of Neurological Disorders and Stroke. Retrieved December 10, 2023, from https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep
- Masters, A., Pandi-Perumal, S. R., Seixas, A., Girardin, J. L., & McFarlane, S. I. (2014). Melatonin, the Hormone of Darkness: From Sleep Promotion to Ebola Treatment. Brain disorders & therapy, 4(1), 1000151. https://doi.org/10.4172/2168-975X.1000151
- Sleepwalking. (n.d.). Medlineplus.gov. Retrieved December 10, 2023, from https://medlineplus.gov/ency/article/000808.htm
- Waller, E. A., Bendel, R. E., & Kaplan, J. (2008). Sleep disorders and the eye. Mayo Clinic Proceedings, 83(11), 1251–1261. https://doi.org/10.4065/83.11.1251
- Pereira, M. V., & Glória, A. L. (2010). Lagophthalmos. Seminars in ophthalmology, 25(3), 72–78. https://doi.org/10.3109/08820538.2010.488578
- Dry eye syndrome. (n.d.). Medlineplus.gov. Retrieved December 10, 2023, from https://medlineplus.gov/ency/article/000426.htm
