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Main problem regarding corneal exposure

What is lagophthalmos?

Lagophthalmos refers to the inability to completely close the eyelids. The space left between the upper and lower eyelids causes the ocular surface to become exposed, resulting in problems of dryness that can become serious and threaten the integrity of the eye and the quality of vision.

Lagoftalmos y cirugía de párpados. Dr. Medel de IMO Barcelona

What causes it?

Lagophthalmos can occur for several reasons: Paralytic: the facial nerve is responsible for transmitting information to the muscle that closes the eyelids (orbicularis). When this nerve is damaged (facial paralysis, tumours, trauma, cerebrovascular disease, etc.), the muscle loses strength and cannot close the eyelids. Mechanical: this occurs when the nerves in the muscle function correctly, but an external factor prevents closing, such as scars on the eyelids or conjunctiva, eyelid retraction, exophthalmos or eyelid laxity.

How can it be prevented?

In general, lagophthalmos cannot be prevented, unless it is a result of eyelid retraction after blepharoplasty surgery through the skin or other surgical scars. In principle, it is important to detect it, in order to establish whether it poses any risk to vision or the eye and to take steps to treat it.

Secondary symptoms, resulting from exposure of the ocular surface and its subsequent drying, include:

  • Foreign body sensation.
  • Tearing.
  • Blurred vision.
  • Eye irritation.

When lagophthalmos is mild and causes very few or no symptoms of dryness, treatment basically consists of lubricating the ocular surface to prevent future complications.

In more serious cases, in addition to using lubricant therapy, patients can opt for surgical correction, the type of which depends on the degree of exposure and the residual function of the orbicularis muscle in the upper or lower eyelid.

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