Lagophthalmos: An Eyelid Surgery Complication

Can't Close Your Eyes after your Eyelid Surgery? 

The inability to completely close one's eyes (lagophthalmos) after an eyelid surgery can be devastating and life-changing.  Difficulty washing one's face can be a problem since soap can get into one's eyes with a lagophthalmos.  Excessive dry eyes are also associated with lagophthalmos, and can be very bothersome.  The condition, lagophthalmos, can occur after a blepharoplasty or eyelid procedure.  In the majority of cases, post-surgical lagophthalmos resolves several days or weeks  after a blepharoplasty procedure. 

Tear by NessaLand (Photograph Courtesy of Wikimedia Commons)

Fast Facts about Lagophthalmos after Blepharoplasty

• Lagophthalmos occuring after eyelid surgery maybe secondary to scarring in one of the layers of the eyelid (middle lamellae) or secondary to excessive skin resection.
• In mild cases, lagophthalmos is mostly temporary and may resolve after intermittent eyelid massage.
• Poor eyelid closure from lagophthalmos may lead to worsening of dry eyes.   This may lead to exposure keratoconjunctivitis (inflammation of the conjunctiva and cornea of the eye).
• If this persists more than 6 months after an eyelid surgery, surgical correction may be required.
• Surgical correction may consist of skin graft placement or lysis of adhesions between the preseptal orbicularis muscle, the orbital septum and levator aponeurosis (different layers of the upper eyelid.)

What Does one need to do if One has Lagophthalmos or Inability to Completely Close the Eyes?

• Artificial tears may need to be applied to one's eyes very frequently.
• Lubricating eye ointments should be applied before bedtime.
• In severe lagophthalmos, a moisture chamber over the eyes (such as Tegaderm) may need to be used during sleep.

Unfortunately, complications may arise after any surgical procedure even with "the best techniques in the best of hands".  Even the most skilled plastic surgeon will encounter surgical complications, such as lagophthalmos, at any time during one's surgical career.  For the surgeon, prevention is the key.  For the patient, education about one's surgery is critical.  One should be aware of the risks and signs of complications of an eyelid surgery, such as infection, lagophthalmos and loss of vision.  I recommend to always ask your plastic surgeon information about your plastic surgery before one undergoes any procedure. 

Emmanuel De La Cruz M.D.

References:

Airiani S, Braunstein R E, Kazim M, Schrier A, Auran J D, Srinivasan B D. Tegaderm transparent dressing (3M) for the treatment of chronic exposure keratopathy. Ophthalmic Plast Reconstr Surg. 2003;19:75–76.

Klapper, et al.  Management of Cosmetic Eyelid Surgery Complications. Semin Plast Surg. 2007 February; 21(1): 80–93.

Wilkins R B, Byrd W A. Complications of blepharoplasty. Ophthal Plast Reconstr Surg. 1985;1:195–198.