As you know, the surface of the eyes is constantly moistened by regular blinking and complete closure of the eyelids with it. That is how the cornea and the visual organ itself are protected. But due to the inability to fully close the eyelids, this important property is lost. Against this background, there is a violation of the integrity of the tear film, which is accompanied by abnormal changes in the conjunctiva.
Lagophthalmus is an incomplete closure of the eyelids. With this pathology, even at the time of sleep, the patient’s palpebral fissure closes only partially. This disease is also known by another name - "hare eye".
General information
Lagophthalmus is a pathology characterized by a partial closure of the eyelids due to the impossibility of closing them. According to statistics, this is a fairly common and serious illness. In the absence of appropriate therapy, lagophthalmos can provoke the onset of keratitis, dystrophy and ulceration of the cornea.
Pathology often has paralytic pathogenesis. Lagophthalmos is equally common in both women and men. He does not possess seasonal and geographical features.
In normal condition, the eyelids are fully closed, which helps to fully moisturize the cornea. But the influence of numerous external and internal factors entails discord in this physiological process. Against this background, a gaping of the palpebral fissure occurs, and the damaged eye remains slightly ajar even during sleep. Gradually, the anomaly provokes severe drying of the cornea and a violation of its trophism. All these processes cause the appearance of ulcers and even complete loss of vision.
Lagophthalmus is a disease that can lead a patient to disability. That is why this vice carries an important social value.
The code of lagophthalmus according to ICD-10 is 02.2.
Development reasons
Disorders in the full process of closing the eyelids can occur due to the influence of certain provoking conditions. The causes of lagophthalmus can be a variety of factors.
- Paralysis or paresis of the facial nerve. This defect provokes abnormal changes in the innervation of the eye muscles that control the mobility of the eyelids. These processes can occur as a result of serious illnesses, surgical intervention and various injuries.
- Anomalies of development. Lagophthalmus often develops due to simblepharon or coloboma, which also interfere with the full mobility of the eyelids. As a result, the conjunctiva is only partially closed in the cleavage zone.
- Diseases of the trigeminal nerve. With such damage, the disorder concerns not only motor function, but also tactile sensitivity, tear fluid production, which leads to pain.
- Exophthalmos. As a result of the abnormal movement of the eyeball, the closing of the eye is disrupted.
- The occurrence of cicatricial eversion. Ectropion provokes sagging of the lower eyelid, due to which the eyelids cease to completely close.
- Retraction of the upper eyelid. This disease leads to a shift of the skin fold towards the upper edge of the eye, against the background of which the sclera is exposed.
Etiology
Lagophthalmos is a disease that can have both an innate and acquired character. But most often, pathology occurs due to injuries resulting from mechanical damage.
Other prerequisites for the development of this disease may be:
- trachoma;
- vitamin A deficiency;
- pemphigus - blistering rashes in the skin of the eyelids and conjunctiva.
There are other provoking factors that can affect the onset of lagophthalmos:
- hypothermia;
- inflammation of the salivary gland near the ear;
- meningitis;
- flu;
- damage to the face and skull;
- infectious ailments;
- diseases of the hearing aid;
- abnormalities in the central nervous system.
Classification
According to the severity of the clinical manifestations of the disease, several of its varieties are shared.
- Light form. Defect provokes a slight expansion of the palpebral fissure and prolapse of the lower edge of the eyelid. At the same time, the victim is almost completely able to close his eyes, although in the dream the palpebral fissure does not close completely.
- Medium degree. Deficiency is characterized by pronounced symptoms, a typical decrease in skin folding. The patient needs to make a lot of effort to completely close the eyelids. At the time of rest, the damaged eye remains open.
- Severe form. This stage of the disease leads to the fact that the patient is simply not able to completely close his eyes. As a result, the conjunctiva and the cornea of the organ dry out very much, due to which inflammatory and dystrophic processes develop.
Clinical picture
Pathology can affect one or both eyes at the same time. A photo of lagophthalmus (presented above) is the best way to visually see the visual signs of the disease. As for other manifestations, in the early stages of the disease, the patient may experience:
- redness of the eyes, especially noticeable after sleep;
- feeling of dryness;
- fear of light;
- burning in eyes and constant feeling that something has gotten inside;
- discomfort or pain;
- decreased visual acuity or blurred vision.
The obvious symptoms of lagophthalmus are its visual manifestations, which include:
- a significant increase in the palpebral fissure in the damaged area;
- intense lacrimation;
- noticeable lowering of the lower eyelid, as well as its separation from the eyeball.
Gradually, the disease progresses, and the patient has more serious symptoms: over time, the corneal reflex is lost, due to which the cornea is irritated and the eyelids stop closing. Eyes cannot fully close during rest. And profuse lacrimation is caused by an eversion of the lacrimal opening.
At the last stage of the defect, the conjunctiva and the cornea dry out, which, in turn, provokes the appearance of complications. So, with lagophthalmos, erosion, keratitis and clouding of the cornea may occur.
Diagnostics
If you suspect a lagophthalmus, the optometrist first of all carries out a thorough examination of the victim. To determine the severity of the pathological process, the patient should try to close the eyelids. With a mild form of defect, it is necessary to undergo a special ophthalmological examination, which provides for several basic procedures.
- Biomicroscopy This manipulation makes it possible to identify the degree of damage to the conjunctiva and cornea. If at the same time infectious or inflammatory processes in the visual organ were detected, then surgical intervention is possible only after additional treatment of these pathologies.
- Visometry Determination of visual acuity in cases of suspected lagophthalmos is an obligatory stage of diagnosis, since a defect can provoke severe visual dysfunction.
- Ultrasound in mode B. An examination is required if there is a suspicion of the appearance of pan-or endophthalmitis. If inflammatory processes are detected, such manipulation is contraindicated. In such cases, the use of optical coherence tomography is allowed.
In general, it is not at all difficult to recognize this disease. After all, as a rule, it is noticeable with the naked eye and looks like a cosmetic defect on the face. The diagnosis of lagophthalmos can be made on the basis of clinical manifestations. Differential diagnosis in this case should be aimed at checking for the presence of an eversion of the eyelids.
If lagophthalmus has arisen due to paresis or paralysis, the patient needs additional consultation with a neurologist. If abnormalities in the thyroid gland are detected, the victim needs an examination by an endocrinologist.
Lagophthalmus treatment
The algorithm of therapy depends primarily on the causes of the development of pathology. In the early stages of lagophthalmus, regardless of pathogenesis, the use of certain medications is recommended:
- antiseptic agents prevent the onset of inflammatory and infectious ailments;
- moisturizing drugs with regular use can get rid of the main symptoms of pathology;
- artificial tears are used to moisturize the eyes;
- antibiotics in the form of ointments are prescribed when bacterial infections are detected;
- anti-inflammatory drugs are recommended in the presence of inflammatory and infectious processes in the visual organ.
Surgical intervention
If the causes of the disease are congenital or it is rapidly progressing, surgery is necessary for lagophthalmos. Severe forms of pathology or the development of serious complications are also an indication for surgical intervention. There are several types of operations, the choice of which depends on the characteristics of the disease:
- installation of the implant in the upper eyelid;
- plastic of the palpebral fissure;
- suspension of the lower eyelid;
- the introduction of silicone thread along the entire length of the eye;
- scar removal;
- adjustment of the muscles that control the lifting of the eyelid.
During the rehabilitation period, it is desirable to place the patient in a spa with a medical bias. Of great importance in the recovery period is exercise therapy.
Prevention
To prevent the occurrence of a disease such as lagophthalmus, you must:
- treat ocular pathologies on time;
- Avoid eye injury
- select the right therapy for neuritis of the facial nerve;
- avoid burns to the visual organs.
For protection, it is recommended that you also use soft contact lenses.