People with nocturnal lagophthalmos may experience daytime issues as well since some don’t have a full blink and the eyelids do not fully close day or night. That means that at least part of the eye never receives enough tear lubrication, and it’s continually exposed to the open atmosphere. This can cause affected eyes to dry out and makes them feel tired and/or itchy.
Babies and young children may sleep with their eyes open more often than others, but they often outgrow it. It’s also prevalent among older adults due to changes in eyelid tissue.
Why Some People Sleep With Their Eyes Open
It may sound strange, but sleeping with your eyes open is actually considered a form of facial paralysis; it involves the orbicularis muscle in the eyelid and may be temporary or permanent. It can be caused by several things, including Bell’s palsy, infection, stroke, surgery, and trauma.
You may also start to sleep with your eyes open after undergoing upper blepharoplasty. Blepharoplasty is a procedure used to remove excess skin on the upper eyelid (suprapalpebral hooding) that often occurs with aging. The procedure can help you see better as well as look younger. However, if too much upper eyelid skin is removed, the lagophthalmos may develop.
What Nocturnal Lagophthalmos Feels Like
Obviously, unless you video yourself while sleeping, you won’t realize you sleep with your eyes open until you experience symptoms.
If you have nocturnal lagophthalmos, you may awaken with dry eye symptoms such as:
Feeling like something is in your eyeRednessPainBlurry vision
Some people also experience increased light sensitivity.
Complications
Your eyelids provide a barrier, allowing tears to lubricate the surface of your eyes. Along with nutrients, tears have natural antibiotics to help kill viruses and bacteria.
When you sleep with your eyes open, that barrier is broken. Your eye becomes exposed to the outside environment and the tear film begins to evaporate almost immediately.
When this occurs night after night, your eyes can become inflamed and the cornea and conjunctiva may form dry spots, ulcers, and even scarring if not treated.
Diagnosis
Lagophthalmos is actually often confused with chronic dry eye syndrome, as symptoms closely mimic each other. Your eye doctor will be able to determine if you are suffering from dry eye syndrome by conducting a comprehensive eye exam.
Your tear production can be measured to make sure your eyes are producing adequate moisture. The Schirmer test is used to measure your tears. During the test, small strips of paper are placed under your lower eyelids. After a few minutes, your doctor will measure how much of the strip was soaked up by your tears.
Other tests can be used to determine the quality of your tears. Special dyes in eye drops can be instilled in your eyes to determine the surface condition of your eyes. Staining patterns on the corneas will determine the amount of time it takes your tears to evaporate.
Treatment for Sleeping With Your Eyes Open
Treatment for sleeping with your eyes open often involves managing eye irritation. Your healthcare provider may recommend using artificial tear eye drops several times per day along with a bland eye gel or ointment at bedtime. Ointments may be applied to the cornea at bedtime in severe cases. Because ointments can cause vision to blur, most people can only tolerate them during sleep.
To prevent the eyelid from opening at night, medical-grade hypoallergenic tape may be gently applied to the eyelid to keep it closed. A mask worn over the eyes may also help. Your healthcare provider may also recommend that you turn down or turn off ceiling fans.
In severe cases, a gold weight may be applied to the outside of the eyelid or surgically implanted inside the eyelid. The gold weight is compatible with the body and uses nature’s gravity to help provide a full blink.
Another more recent treatment option is scleral contact lenses or corneal gas permeable lenses which cover the cornea and create a more natural and protected environment on the surface of the eye.
A Word From Verywell
Don’t be afraid to ask your healthcare provider if you might be experiencing lagophthalmos. Sometimes it is difficult to know, as your eyes may be dry due to other causes such as dry eye syndrome.
The effects of sleeping with open eyes can be severe. Treatments could significantly improve your quality of life.
