Lagophthalmos

Synonym(s): Hare’s eye

[G. lagos, hare + ophthalmos, eye]

Definition:
Lagophthalmos is defined as the inability to close the eyelids completely. A condition in which a complete closure of the eyelids over the eyeball is difficult or impossible.

Blinking covers the eye with a thin layer of tear fluid, thereby promoting a moist environment necessary for the cells of the exterior part of the eye. The tears also flush out foreign bodies and wash them away. This is crucial to maintain lubrication and proper eye health. If this process is impaired, as in lagophthalmos, the eye can suffer abrasions and infections. Lagopthalmos leads to corneal drying and ulceration.

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Nocturnal lagophthalmos is the inability to close the eyelids during sleep. Lagophthalmos is associated with exposure keratopathy, poor sleep, and persistent exposure-related symptoms.

Detection:There are a variety of causes of lagophthalmos, grouped as proptosis/eye exposure etiologies and palpebral insufficiency etiologies. Although obvious lagophthalmos is usually detected, it is sometimes difficult to recognize obscure lagophthalmos, due either to eyelash obstruction or overhang of the upper lid anterior and inferior to the most superior portion of the lower lid in a closed position. A novel classification system and illustrations of obvious and obscure lagophthalmos for detection.

Causes:
The inability to provide function to the eyelid is typically secondary to a previous or ongoing condition, surgery, or event. This paralysis is usually isolated to just one side of the face. Lagophthalmos and facial paralysis are typically diagnosed due to:

*Bell’s Palsy
*Trauma
*Neurosurgery
*Bacterial infection
*Cerebral vascular accidents (strokes)

Pathophysiology
Lagophtalmos can arise from a malfunction of the Facial nerve. Lagopthalmos can also occur in comatose patients having a decrease in orbicularis tone, in patients having palsy of the facial nerve (7th cranial nerve), and in people with severe skin disorders such as ichthyosis.

Risk Factors:
Your eyelids play a crucial role in protecting and providing nourishment to your eyes. When blinking or eyelid closure function is lost, the health of your eyes can be at risk. Many experts have noted several complications associated with lagophthalmos:

*Severe dry eye and discomfort
*Corneal ulceration (damage to the cornea-the clear tissue covering the front of your eye)
*Decrease or loss of vision
*Unsatisfactory appearance

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Diagnosis:

A diagnosis can usually be made with a focused history and slit lamp examination. Treatment is multipronged and may include minor procedures or ocular surgery to correct the lid malposition; natural, topical or oral agents; and punctal plugs to manage ocular surface effects. Correct and timely diagnosis allows greater opportunity for relief of patient suffering and prevention of severe ocular surface pathology, as well as educated planning for future ocular surgical procedures.

Treatment:
Today, lagopthalmos is most likely to arise after an inexperienced or unwise cosmetic/plastic surgeon performs an overenthusiastic upper blepharoplasty, which is an operation performed to remove excessive skin overlying the upper eyelid (suprapalpebral hooding) that often occurs with aging. This can appreciably improve the patient’s appearance, and make the patient look younger. If, however, excessive skin is removed, the appearance is unnatural and “lagopthalmos” is one of the signs of such excessive skin removal.

It all begins with your diagnosis of your condition by your ophthalmologist. Typically, if your paralysis is expected to last less than six months, your doctor will recommend the use of drops and ointments throughout the day to help maintain a well-nourished eye.

If your paralysis is deemed permanent or persists without improvement, your surgeon may want to perform surgery to control the paralysis and provide a more natural function to your eyelid. The most common surgical procedure involves the placement of a small, pure-gold eyelid weight into your eyelid. This procedure very simple and is typically performed under local anesthesia in an outpatient setting.

How Does The Gold Eyelid Weight Work?

It’s very simple. The appropriate implant ‘weight’ will be selected your physician. When implanted into your lid margin, the weight will essentially allow earth’s gravity to gently pull your eye closed when your muscles relax. However, this will not affect your ability to open your eye…. when you tense the muscle, your eyelid will open normally.

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Is Gold A Safe Material?
Each weight is made from 99.99% gold (pure gold). Pure gold is an excellent material because it is biologically stable and inert. Because the gold will never break down, your surgeon can always remove it if deemed necessary. Gold has been used for decades for the treatment of lagophthalmos and is recognized by experts as an extremely safe and effective device material. If you have a known sensitivity or allergy to gold, notify your physician before surgery.

What Happens During Surgery? How Is The Gold Weight Implanted?
Gold eyelid weight surgery is usually performed under local anesthesia in an outpatient setting. Previous to the day of the surgery, your physician will have selected the appropriate gold weight size for your specific needs.

During the procedure, your physician will first make a small incision in your eyelid, just above your eyelashes. This incision will allow your physician to create a small pocket inside your lid for the gold implant to rest. The weight will be secured to your lid with sutures. Each weight contains small channels or grooves to house the sutures below the surface of the implant. The incision is closed with sutures. A protective pad will be applied to cover your eyelid.

What Happens After Surgery? What Should I Expect Regarding The Function And Appearance Of My Eyelid?

As always, your condition and progress will be closely monitored by your physician. Following the removal of your eye protection, you should be able to experience normal blinking and eyelid closure function.

Like any surgery, the incision will take time to heal. If you experience significant discomfort or swelling around the incision, contact your physician immediately.

Any questions or concerns you have about your surgery can best be answered by your surgeon. You can best insure the best outcome for your procedure by carefully following your surgeon’s instructions.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Lagophthalmos
http://www.iopinc.com/patient_link/lagophthalmos.asp
http://www.drugs.com/dict/lagophthalmos.html
http://www.ncbi.nlm.nih.gov/pubmed/16671223

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