Because nocturnal lagophthalmos can significantly affect both sleep quality and eye health, it is beneficial to know the signs of this condition and how to treat it.
Sleeping With Your Eyes Open
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Closing your eyes is a defining feature of sleep. For that reason, it may be surprising to learn that some people sleep with their eyes partially or fully open. This condition, known as nocturnal lagophthalmos, is relatively common. Research studies indicate that about 1 in 20 people Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source do not shut their eyes while sleeping.
Because nocturnal lagophthalmos can significantly affect both sleep quality and eye health, it is beneficial to know the signs of this condition and how to treat it.
Why Do We Close Our Eyes During Sleep?
Our eyelids play an important role in getting a good night’s sleep. Eyelids act as a protective barrier, keeping the eyes safe from debris. They also provide lubrication and prevent the eyes from drying out.
Closing our eyes also blocks light, which is crucial for calibrating the body’s internal 24-hour clock. Specific cells Trusted Source National Institute of Neurological Disorders and Stroke (NINDS) NINDS aims to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. View Source in the retina process light and send information to the hypothalamus, signaling that it’s time to be awake. When we experience darkness, melatonin is produced, telling our body it’s time to sleep.
What Causes You to Sleep With Your Eyes Open?
Nocturnal lagophthalmos can have many causes, including faulty eyelid mechanics, facial nerve disorders, and structural changes in the face. Numerous conditions Trusted Source Science Direct The leading platform of peer-reviewed literature that helps you move your research forward. View Source can predispose individuals to these issues:
- Proptosis (Bulging Eyeball): When the eyeball protrudes, it creates more surface area for the eyelids to cover. Possible causes of proptosis include thyroid disorders like Graves disease, congenital conditions affecting the anatomy of the face, an infection, or a tumor.
- Short or Weak Eyelids: Numerous conditions can either shorten the eyelids or decrease their muscle tone, thereby preventing the eyelids from fully closing. Medical procedures like eyelid-tightening surgery, Botox injection, and fat removal around the eyes can compromise eyelid height and tone.
- Scarring: Physical trauma, chemical burn, and certain diseases such as ocular pemphigoid and Stevens-Johnson syndrome, can scar components of the eyelids and limit their function.
- Nerve Problems: A range of problems Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source affecting facial nerves can prevent the eyelids from functioning properly. These problems include Bell’s palsy, Lyme disease, and injuries.
- Sedatives: Excessive alcohol and sedatives, including some sleeping pills, can sometimes cause nocturnal lagophthalmos.
- Idiopathic: When there is no known cause for nocturnal lagophthalmos, it is classified as idiopathic.
In some circumstances, a person’s eyes can be open while they’re asleep without it meaning they have nocturnal lagophthalmos. For example, people who sleepwalk frequently have their eyes open during sleepwalking episodes. However, sleepwalking is considered a separate issue Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source from nocturnal lagophthalmos.
Signs You May Be Sleeping With Your Eyes Open
Not everyone with nocturnal lagophthalmos notices symptoms. The symptoms a person experiences depend on the severity of the condition and a person’s age. Because ocular lubrication mitigates the drying effect of nocturnal lagophthalmos, older adults are more likely to have symptoms due to age-related reduction in tear quality and production.
Nocturnal lagophthalmos symptoms are usually the worst in the morning and improve over the course of the day. Possible symptoms include:
- Dry eyes
- Sore or painful eyes
- A feeling of irritation
- Watery eyes
- Blurry vision
- Red eyes
Over time, nocturnal lagophthalmos may damage the cornea from persistent dryness — a condition called keratitis — and increase the risk of corneal ulcers, perforation, and vision loss Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .
Studies have found that people who experience nocturnal lagophthalmos have poor sleep quality Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , mostly likely due to discomfort. Some research indicates that the light entering through open eyelids causes sleepers to awaken from visual stimulation Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .
Diagnosing Lagophthalmos
If a doctor suspects nocturnal lagophthalmos, they typically begin the diagnostic process by observing the eyes from a distance. They also thoroughly discuss symptoms, predisposing conditions, and family history with the person experiencing symptoms.
Based on the initial consultation, the doctor may recommend a slit lamp examination. This procedure uses a low-power microscope to examine structures in the eye. The doctor may also ask the person experiencing symptoms to blink, and use gloved hands to move the eyelids and check for signs of nerve dysfunction.
A special assessment is often done since this is an important component of developing a patient’s treatment plan.
Treatment for Sleeping With Your Eyes Open
The treatment given for nocturnal lagophthalmos varies depending on its cause and the severity of symptoms. If possible, it is important to correct any underlying condition contributing to the problem. For example, a person with nerve damage might consult a neurologist, or someone with a thyroid disorder may require endocrine therapy.
The first goal of treating nocturnal lagophthalmos is to improve dry-eye and prevent keratitis Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . People experiencing symptoms may be given eye drops to provide lubrication for waking hours and an ointment for bedtime. In more severe cases, doctors may recommend using special tape to keep the eyes shut at night, or a goggle-like device that provides moisture during sleep.
If you’re diagnosed with nocturnal lagophthalmos, it may be appropriate to make adjustments to your sleeping environment to counteract its effects. Make sure the room is kept dark so that light does not enter and contribute to awakenings. Using a humidifier or moving your bed away from dry airflow can also lessen dry-eye.
People experiencing nocturnal lagophthalmos are encouraged to limit alcohol or sedatives before bed. It’s also important to keep the eyes clean and free of debris since insufficient lubrication increases the risk of infection. People with nocturnal lagophthalmos might find it helpful to practice blinking Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source more frequently and fully during waking hours to ensure the eyes have sufficient moisture.
Some people may require surgical intervention to treat nocturnal lagophthalmos. Relevant surgical techniques include skin grafting, sewing the eyelids closer together, or implanting tiny gold weights in the eyelids. Although these approaches may sound drastic, they are generally well-tolerated and effective.
When To Talk to Your Doctor
Nocturnal lagophthalmos can be hard to diagnose on your own. Even if another person observes you while you sleep, very small eyelid openings may be obscured by eyelashes and go undetected.
If you’re having persistent eye symptoms, particularly dry-eye that is worse in the morning, it may be helpful to see a doctor for specialized testing. If left untreated, nocturnal lagophthalmos can significantly affect your eye health and compromise sleep. Getting a proper diagnosis and tailored treatment plan will help you get the quality shut-eye you need.
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The Perils of Sleeping With Your Eyes Open
Did someone inform you that you sleep with your eyes open? Chances are, you are not aware your eyes aren’t entirely closed while you are asleep.
What Is Nocturnal Lagophthalmos?
If you are sleeping with eyes open, or at least your eyelids only partially closed, is termed nocturnal lagophthalmos. It tends to be rather prevalent in young children. However, they often outgrow the condition. It is also common in older adults due to changes in the eyelid tissue.
Nocturnal lagophthalmos can also happen during day time. Patients with this problem do not have a complete blink, so there is always a part of the eye that does not receive sufficient tear lubrication.
When your eyelids do not sufficiently close, your eyes are exposed to the open environment. Because your eyelids lubricate the surface of your eyes, your eyes begin to dry out notably. You may wake in the morning, feeling like your eyes are dry, tired, and itchy.
The Role of Your Eyelids
Your eyelids provide a barrier, permitting tears to lubricate the exterior of your eyes. Along with nutrients, tears have innate antibiotics to kill bacteria and viruses. When the barrier is busted, your eye becomes exposed to the outside atmosphere, and the tear film begins to evaporate almost instantly. When this happens night after night, your eyes may become inflamed, and the conjunctiva and cornea can form ulcers, dry spots, and even scarring if not dealt with.
Causes of Nocturnal Lagophthalmos
It may sound weird, but nocturnal lagophthalmos is actually considered a type of facial paralysis; it comprises the orbicularis muscle in the eyelid and can be permanent or temporary. It can be triggered by multiple things, including infection, Bell’s palsy, stroke, surgery, and trauma.
Lagophthalmos may also develop after undergoing an upper blepharoplasty. Blepharoplasty is a method used to remove excess skin on the upper eyelid (supra-palpebral hooding) that often occurs with aging. The process can help you see better as well as look younger. However, if excessive upper eyelid skin is removed, the lagophthalmos may grow up.
What Nocturnal Lagophthalmos Feels Like
Unless you record(video) yourself while sleeping, you won’t realize you sleep with your eyes open until you experience symptoms. If you go through nocturnal lagophthalmos, you may awaken with dry eye symptoms such as feeling like something is in your eye, pain, redness, and blurry vision. Some people also report increased light sensitivity.
Lagophthalmos is often confused with chronic dry eye syndrome, as symptoms closely resemble each other. Your ophthalmologist will be able to determine if you are suffering from dry eye syndrome by conducting an extensive eye examination.
Your tear generation can be measured to make sure your eyes are secreting adequate moisture. The Schirmer test is applied to measure the tears. During the test, short strips of paper are arranged under your lower eyelids. After a couple of minutes, your physician will measure how much of the strip was absorbed by your tears(1).
Other tests can be examined to figure the nature of your tears. Specialized dyes in eye drops can be employed in your eyes to figure the surface condition of your eyes. Staining patterns on the corneas will figure the amount of time it takes your tears to evaporate.
Treatment of Nocturnal Lagophthalmos
Treatment generally involves artificial tear eye drops given several times per day along with the installation of ointment or a bland eye gel at bedtime. Ointments can be applied to the cornea at bedtime in extreme cases. Because ointments can make vision blur, most people can only bear them while sleeping.
To avoid the eyelid from opening at night, the medical-grade hypoallergenic tape can be gently employed to the eyelid to keep it closed. A mask worn over the eyes can also help. Your physician may also recommend that you turn off or turn down ceiling fans.
In extreme cases, a gold weight can be activated to the outside of the eyelid or surgically implanted inside the eyelid. The gold weight is adaptable with the body and adapts nature’s gravity to help give 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.
What Are the Perils of Sleeping with Your Eyes Open?
People who sleep with their eyes open usually wake to find their eyes red, dry, and disturbed. That’s irritating and uncomfortable in the short term, but there are also possible long term issues that can happen if you regularly sleep with your eyes open.
Sleeping with your eyes open on a regular basis can make your eyes become inflamed and can also lead to ulcers, dry spots, or even scarring on your cornea or the inside of your eyelids.
Final Thoughts
Don’t be afraid to consult your physician 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. However, the effects of sleeping with open eyes can be severe. Treatments could significantly improve your quality of life.
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