Lagophthalmos is a condition in which the eyelids do not fully close, especially during blinking or sleep. Even small gaps in eyelid closure can lead to significant corneal exposure, dryness, irritation, and long-term damage to the ocular surface.
At our Miami Beach optometry clinic, Dr. Rachel Shlomov, OD provides comprehensive evaluation and advanced treatment for lagophthalmos, including scleral contact lenses to protect the cornea and restore comfort. Patients from Miami Beach, Surfside, Bal Harbour, and throughout Miami often seek care when their eyes feel painfully dry, irritated, or fail to heal despite frequent drops.
What is lagophthalmos?
Lagophthalmos occurs when the eyelids cannot fully close, leaving part of the cornea exposed to air. This exposure disrupts the tear film and prevents the eye from staying properly lubricated and protected, particularly during sleep.
Because the cornea relies on blinking and eyelid closure for hydration and healing, lagophthalmos significantly increases the risk of exposure keratopathy, persistent epithelial defects, and infection.
Common causes of lagophthalmos
Lagophthalmos can occur for many reasons, including:
Facial nerve weakness or paralysis
Conditions such as Bell’s palsy, stroke, tumors, or nerve injury can impair eyelid closure.
Post-surgical causes
Lagophthalmos commonly occurs after cosmetic or reconstructive eyelid surgery (blepharoplasty), especially when excessive skin is removed or eyelid mechanics are altered.
Thyroid eye disease
Proptosis (eye bulging) can prevent the eyelids from closing completely.
Trauma or scarring
Injuries, burns, or scarring of the eyelids can mechanically restrict closure.
Nocturnal lagophthalmos
Some patients close their eyes incompletely only during sleep, often without realizing it, leading to severe morning dryness, burning, or pain.
Age-related eyelid changes
Loss of muscle tone and eyelid elasticity over time can contribute to incomplete blinking or closure.
Symptoms of lagophthalmos
Patients with lagophthalmos often experience:
- Severe dryness or burning
- Foreign body sensation
- Redness and irritation
- Blurry or fluctuating vision
- Light sensitivity
- Excessive tearing (reflex tearing)
- Eye pain or discomfort, especially upon waking
- Recurrent corneal abrasions or delayed healing
Symptoms are often worse overnight or in dry, windy, or air-conditioned environments.
How is lagophthalmos diagnosed?
Lagophthalmos is diagnosed through a careful eyelid and ocular surface examination. Evaluation includes:
- Observing eyelid closure during blinking and rest
- Measuring the degree of incomplete closure
- Assessing corneal exposure and staining patterns
- Examining tear film stability and corneal health
Fluorescein staining helps identify areas of exposure-related epithelial damage.
Why eye drops alone are often not enough
While artificial tears and ointments can provide temporary lubrication, they do not physically protect the cornea from ongoing exposure. In moderate to severe cases, drops alone are insufficient to prevent epithelial breakdown or corneal injury.
Mechanical protection of the ocular surface is often necessary.
How scleral lenses help with lagophthalmos
Scleral lenses are one of the most effective non-surgical treatments for lagophthalmos-related corneal exposure.
These large-diameter rigid gas permeable lenses vault over the cornea and rest on the sclera. Before insertion, the lens is filled with preservative-free saline, creating a sealed fluid reservoir that continuously bathes the cornea throughout the day.
Benefits of scleral lenses for lagophthalmos include:
- Constant hydration of the cornea
- Physical protection from air exposure
- Shielding from blinking friction and external irritants
- Promotion of epithelial healing
- Improved visual clarity in eyes with irregular surfaces
- Reduced reliance on frequent drops or ointments
For many patients, scleral lenses provide relief when all other treatments have failed.
Additional treatment options
Depending on severity and cause, treatment may also include:
- Nighttime ointments or moisture goggles
- Eyelid taping during sleep
- Temporary or permanent punctal occlusion
- Amniotic membrane therapy (such as Prokera) for corneal healing
- Referral for surgical eyelid correction in select cases
Treatment is individualized based on the cause of lagophthalmos and the health of the cornea.
Why early treatment is critical
Untreated lagophthalmos can lead to:
- Chronic exposure keratopathy
- Recurrent corneal erosions
- Infection
- Scarring
- Permanent vision loss
Early diagnosis and proactive corneal protection significantly improve outcomes and comfort.
Why choose Dr. Rachel Shlomov for lagophthalmos care in Miami Beach?
Dr. Rachel Shlomov, OD specializes in ocular surface disease and specialty contact lenses, including scleral lenses for exposure-related conditions. Her approach focuses on identifying the underlying cause of lagophthalmos and implementing advanced, non-surgical solutions to protect the cornea and preserve vision.
Patients from Miami Beach, Surfside, Bal Harbour, and the surrounding Miami area trust her expertise when standard dry eye treatments are no longer enough.
Lagophthalmos & Exposure Keratopathy Care Near Surfside, Bal Harbour & Miami
If you experience severe dryness, irritation, or corneal injury due to incomplete eyelid closure, specialized care for lagophthalmos is available in Miami Beach. Advanced diagnostics and scleral lenses can dramatically improve comfort and corneal health.
Schedule a Lagophthalmos Evaluation
If your eyes feel painfully dry, irritated, or fail to heal, especially overnight, schedule a comprehensive evaluation with Dr. Rachel Shlomov to determine whether lagophthalmos is contributing and explore advanced treatment options.