LAGOPHTHALMOS

S
 Definition

• Lagophthalmos refers to inability to

close the eyelid voluntarily
 CAUSES

*Paralysis of orbicularis oculi(facial nerve palsy)

*Marked proptosis(thyroid eye disease, orbital tumor, orbital
cellulitis)
*Cicatricial ectropion
*Surgical overcorrection of ptosis
*Symblepharon
*Comatose patient
 CLINICAL FEATURES

*Inability to close the lids

*Dryness of conjunctiva and cornea due to lack of

tear film resurfacing owing to absence of blinking

*Clinical signs of causative disease

 COMPLICATIONS

*Dessication of conjunctiva and cornea

*Exposure keratitis
*Corneal ulcer perforation
 Treatments
1Measures to prevent exposure keratopathy
* Artificial tear drops should be instilled frequently and the open
palpebral fissure should be filled with an antibiotic eye ointment
following by eyelid taping during sleep and informatised patients.

* Bandage contact lens (BCL) may be used to prevent exposure

keratitis.

*Tarsorrhaphy may be performed to cover the exposed cornea when

indicated.
2. Measures to treat the cause lagophthalmos, wherever possible
should be taken.
Tarsorrhaphy
In this operation, adhesions are created between a part of the lid margins with the aim
to narrow down or almost close the palpebral aperture It is of two types :temporary and
permanent.

Temporary tarsorrhaphy

Indications. (i) To protect the cornea when seventh nerve palsy is expected to
recover(ii) To assist healing of an indolent corneal ulcer. (iii) To assist in healing of
skin-grafts of the lids in the correct position .
Surgical technique. This can be carried out as median or paramedian tarsorrhaphy
i.Incision. For paramedian tarsorrhaphy about 5 mm long incision site is marked on the
corresponding parts of the upper and lower lid margins, 3 mm on either side of the
midline. An incision 2 mm deep is made in the grey line on the marked site and the
marginal epithelium is then excised taking care not to damage the ciliary line anteriorly
and the sharp lid border posteriorly.
ii. Suturing. The raw surfaces thus created on the opposing parts of the lid margins
are then sutured with double-armed 6-0 silk sutures passed through a rubber
bolster.

2. Permanent tarsorrhaphy

Indications. (1) Established cases of VII nerve palsy where there is no chance of
recovery; and (ii) established cases of neuroparalytic keratitis with severe loss of
corneal sensations. Technique. It is performed at the lateral canthus to create
permanent adhesions. The eyelids are overlapped after excising a triangular flap of
skin and orbicularis from the lower lid and corresponding triangular
tarsoconjunctival flap from the upper lid.
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