Sometimes when you wake up, it feels as if your eyes feel dry and tired, as if you haven’t slept at all. Even though dry and sore eyes can hint at lack of sleep, it could be possible that now and then you sleep through the night with your eyes open. Likely, you don’t know anyone who regularly sleeps with open eyes, but bear in mind that this condition isn’t uncommon. Here’s why it happens.
Finding out whether you sleep with your eyes open isn’t all that easy. As eye redness and soreness can be an indicator of many different situations, likely, people with these strange habits are usually told by others. The medical term behind this occurrence is called nocturnal lagophthalmos.
Why Do We Blink And Have Eyelids?
Our eyelids act as a protective barrier, which helps our eyes receive a sufficient amount of lubrication from tear fluid. Tear fluid is extremely important. It helps clean our eyes from the dust and debris, but it also helps kill bacteria and viruses because they feed eyes nutrients, among which are also natural antibiotics.
If your eyes are open for an extended amount of time, your whole eye is exposed to those infections through the air, and the tear fluid starts wearing off, breaking the barrier. If this happens consistently, especially if you sleep with your eyes open, it could lead to damage in your eyes that needs to be treated as soon as possible.
What Is Lagophthalmos?
Nocturnal lagophthalmos is more common than one would think, and it affects 20% of people, according to research. Medical experts and doctors still work hard in finding the reasons behind this occurrence, but one of the reasons suggests that it’s a problem with nerves as well as muscles surrounding our eyes. The muscle or nervous strain could cause the lids not to close in entirety.
Another culprit behind the nocturnal lagophthalmos is some sort of a skin condition surrounding the eyelids, which strains the muscles and prevents the lids from closing. The condition can be quite dangerous because it can cause the eyes, which are mainly composed of water to dry out. If yes don’t receive sufficient lubrication, it is more likely to get an eye infection or suffer an injury or scratch due to not being enough wet.
What Are the Symptoms?
The first symptom that people notice is connected to eyelid discomfort is eyes feeling dry. The reason is obvious. When we sleep, our eye gets hydration through tear fluid that surrounds the eye from the eyelid. Through the day we blink to provide a temporary source of hydration for eyes so they wouldn’t feel dry. However, if our lids aren’t closing while we sleep, our eyes, due to exposure to air, will become dry and sore, which can lead to damage, especially because tear fluid helps clean our eyes from dust.
That said, any eye damage such as scratch or infection can be a result of lack of the necessary lubrication our eye gets from blinking or closing the lids. With that in mind, the nocturnal lagophthalmos is closely linked to dry eyes.
Below, we listed some of the most common symptoms of lagophthalmos.
- Blurred vision
- Red eyes
- Burning sensation
- Scratchiness
- Sensitivity to light
- Poor sleep
- The sensation of having something stuck in the eye
Unfortunately, most of these symptoms are also common symptoms of certain eye infections, so it’s impossible to tell if you’re sleeping with closed eyes. Fortunately, if you sleep with a partner, they may notice and tell you before some serious damage arises.
What Causes Nocturnal Lagophthalmos?
As mentioned above, nocturnal lagophthalmos can be a result of a certain nervous or muscular strain that affects your eyelids. Additionally, a skin condition surrounding your eyelids may also prevent you from closing them properly for a long time. In other words, if there is a condition that leads to paralysis of the muscle that helps you close the eyelids called orbicularis oculi, it can lead to sleeping with eyes open.
Here are the most common causes:
- Traumatic brain injury or some other type of trauma or injury connected to the head.
- Stroke
- Bell’s palsy
- Tumor
- A surgery that was conducted in the area near your eyes, especially on the tumor.
- Autoimmune diseases
- Neuromuscular disease
- Moebius syndrome a condition that causes cranial nerve palsy.
More often than not, nocturnal lagophthalmos can be a result of a physical injury or damage caused to the eyelids that you may have not spotted. The reasons may vary, starting anywhere from eyelid surgery, burns, or even scars caused by other injuries.
Every time the eyelid gets hurt, its shape may change a little to adapt, which may prevent it from closing in entirety.
Research shows that people who have an overly active thyroid gland, a condition is known as hyperthyroidism can also have difficulties sleeping with eyes closed, which may lead to lagophthalmos.
Another reason associated with this odd habit is caused by Graves’ ophthalmopathy which leads to bulging eyes.
Infections
Interestingly, certain viral or bacterial infections can lead to damage in eye muscles that help close the lids. Below, we listed some of those conditions.
- Chickenpox
- Mumps
- Lyme disease
- Polio
- Diphtheria
- Leprosy
- Botulism
Genetic
Lastly, some people may not be able to sleep with their eyes closed without a certain condition, simply because their eyes are like that. In some people, the condition is present because it’s simply genetic and your parents or someone else from the family may have it.
Some people also have thicker eyelashes than others which can lead to difficulties closing your eyes properly. It applies both to upper and lower eyelashes. Nevertheless, in most cases, lagophthalmos is a result of a muscular or nervous condition.
The study found that at least 13% of 40 study participants have the condition because it runs in the family.
Nocturnal Lagophthalmos vs Dry Eye Syndrome (DES)
Given that both have extremely similar symptoms, people tend to mistake one condition for the other. However, there’s a distinct difference between the two conditions. Dry eye syndrome occurs when our eyes are simply dry, as the tear glands don’t produce enough tear fluid to lubricate our eyes. The condition is also called keratoconjunctivitis sicca (KCS.)
Quite different, nocturnal lagophthalmos prevent our eyes from receiving the necessary lubrication because eyes are open at all times, even in sleep, which should be the time our eyes rest and recover.
Does Sleeping With Your Eyes Open Affect Sleep Quality?
Anything that can lead to your eyes feeling sore in the morning can lead to poorer sleep quality. Nocturnal lagophthalmos in particular affects sleep because opened eyes are always a strain, and it’s nearly impossible to induce slow-wave or deep sleep. A lot of people wake up through the night multiple times, without really knowing they’re waking up from lagophthalmos.
If you feel that you’re frequently waking up through the night and have sore eyes, you should schedule an appointment with your doctor as soon as possible so that you can find the underlying reason behind this condition.
Treatment for Sleeping With Eyes Open
When you schedule an appointment, make sure not to miss anything that could potentially help your doctor diagnose you. Ensure to tell them about your recent activities, history of some condition or disease, as well as whether someone in your family has already been diagnosed with that condition or not. Don’t miss on potential injuries that took place in the past, as well as how you discovered that you may have lagophthalmos.
Also, ensure to detail your symptoms and when they started appearing, whether they get worse in the night or when you wake up. Most importantly, tell them whether the symptoms get better through the day, as you’re blinking. Lastly, clarify whether you have ceiling fans or some other bed cooling system as that may also contribute to dry ambient.
Several tests can determine whether you’re sleeping with your eyes open or not. The doctor will likely observe you while your eyes are closed. They will also ask you to close them quickly or slowly or keep them closed for a few minutes, looking for abnormal behavior such as eyelid twitching or something else.
They may conduct several other tests like measuring the space of your eyelids, and the force used for you to close your eyes, blink or keep them closed. Other tests also include a slit lamp exam for observing your eyes using a Microsoft and light. Lastly, a fluorescin eye stain test may be required to look at potential damage.
Once your condition has been diagnosed, the doctor will offer several treatment options to help you sleep easier but also manage to close your eyes completely. Here are some of the treatment options.
Lifestyle Changes
In mild conditions, your doctor won’t suggest you go to surgery or may introduce a few more options that will allow you to sleep peacefully without waking up with dry eyes. Several options include using a humidifier, eyelid weight, or moisture goggles that will help your eyes stay moist even if you sleep with open eyes. Other options also include a surgical tape which may help you keep your eyes closed easier.
Also Read: Where to Place Humidifier in Bedroom?
Medicines
To keep your eyes moist and lubricated, your doctor may prescribe you eye drops or some other medication. Besides eyedrops, the most common treatment options include artificial tears which you’d need to use several times per day or ophthalmic ointments that prevent physical damage like scratching.
Surgery
In the most severe scenario of your condition, the doctor may suggest surgery. The surgery would deploy a surgical implant that will help you close your eyes easier, and minimize the effects of nocturnal lagophthalmos. It works similar to an external eyelid weight, because it will allow you to close the eyelid easier, but it’s more effective and permanent.
The entire procedure doesn’t last long and will include a tiny incision on your eyelid where a small implant goes. It’s closed with stitched and treated with antibiotics until the wound heals. There are a few effects of the surgery, but it isn’t too complicated procedure and the effects heal over time. The most common effects are discomfort, swelling, bruising, and redness. Also, your eyelids may feel like they grew thicker.
Nevertheless, the small golden implant is extremely effective at keeping your eyes closed. Another good news is that the implant or the thickness above your lashes aren’t even noticeable.
Potential Risks
If reading the above paragraphs scares you, you may think that you don’t need treatment for lagophthalmos. But, the bitter truth is, that while this condition is not all that rare, it can lead to consequences that may worsen your vision, not to mention the sleep effects it leaves on people who want to nourish a healthy sleep cycle.
Sleeping with your eye open won’t cause any immediate damage, but it can lead to your eyes becoming dehydrated which can result in numerous eye infections, common injuries, loss of vision, or corneal ulcer in the eye. The eye dehydration can lead to exposure keratopathy, which defines as a damage to the cornea, which is the external later of the eye.
Conclusion
Nocturnal lagophthalmos is a condition that doesn’t go noticed all that easily, especially if you live alone. Only when people feel that their eyes are extremely sore or weak they visit the doctor, getting shocked at the discovery of a condition they could never believe they had.
Sleeping with eyes open isn’t normal, but fortunately, the treatment procedure is straightforward and relatively easy. Small adaptations and medicines should be enough to improve your sleep quality and eye lubrication. However, in more severe cases, surgery is mandatory.
Keep in mind that lagophthalmos is an indicator of another infection, so early detection is the key to proper treatment.
