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Nocturnal lagophthalmos cure11/8/2023 Finding a solution that produces the desired effect of absence of symptoms upon arising is critical.Ĭase study A healthy Caucasian female, age 53, was referred by her primary-care physician due to ongoing problems with dry eye. Related: How to treat dry eye in the pediatric and young adult population Moisture-chamber goggles designed specifically for the management of dry eye symptoms, including eyeseals or Onyix goggles (Eye Eco), are another option. Saran Wrap or Cling Wrap combined with fabric sleep masks can also work, with the goal of creating a periorbital high humidity microenvironment. Other interventions, such as use of surgical tape or Breathe Right nasal strips can be used to secure the lids together. For others, these simple masks are inadequate. When ointments do not work, fabric sleep masks which can keep the eyes closed may be recommended. Related: Use aesthetics to treat lid and periorbital conditions 4 In my experience, ointments can be effective, but they can also irritate a patient’s eyes, blur vision in the morning, fail to protect the eye from desiccating stress, or be contraindicated by medications or comorbidities. This erroneous assumption was perpetuated by NIH definitions of dry eye, which until recently focused on aqueous deficiencies as the major cause of dry eye. Typical recommendations for morning dryness include drops used before bedtime, on the assumption that inadequate lubrication is the primary challenge. Asking the patient to then tightly squeeze her eyes shut will reveal whether they are capable of complete closure.Ĭontemporary treatment strategies Historically, poor awareness of the problem and lack of a diagnostic test prevented identification and treatment of this condition. Application of a transilluminator placed at the upper tarsal plate will show leakage of light onto the cheek if NL is present. Related: Explore the relationship between dry eye and sleepĪ simple method for detecting NL is the Korb-Blackie light test, wherein a practitioner places the patient in a darkened room, instructing her to gently close her eyes as if sleeping. It wasn’t until 2015 that researchers realized that, even though lids may appear to be closed, if they are not properly “sealed, air will reach the ocular surface, resulting in evaporative stress and associated symptoms upon awakening. Even to discerning clinicians, this has been an enigma. Standard methods of examination often indicate that lids appear capable of full closure, even though signs and symptom severity peaks in the morning. Related: Common systemic conditions associated with dry eye disease Many situations in which discomfort worsens in the morning (upon waking) and resolves slowly throughout the day do not lead to objective clinical findings, making a satisfactory diagnosis elusive. In clinical practice, a common scenario involves a patient complaining about ocular discomfort with no obvious cause. However, more subtle forms (such as lid seal deficiency occurring in patients with normal lid configurations) are frequently overlooked. 1,2ĭiagnosing NL NL is easily recognized when a patient presents with significant lid deformities. It is difficult to successfully treat any dry eye condition if NL is not effectively managed.Ĭommon triggers for NL include cosmetic surgical procedures, Botox (onabotulinumtoxinA injection, Allergan), Grave’s disease, floppy eyelid syndrome associated with sleep apnea and keratoconus, high axial myopia, lid deformities, age-related lid laxity, senile ectropion, and dermatochalasis. NL should be proactively investigated and addressed as, from my experience, it can greatly exacerbate other forms of dry eye (such as aqueous-deficient, Bell’s palsy, medication-induced, etc.). The problems associated with NL manifest similarly to those from inadequate blinking during the day or prolonged screen use: namely, symptoms of dryness and irritation due to enhanced tear film evaporation, with ensuing ocular surface inflammation. Nocturnal lagophthalmos (NL) describes incomplete eyelid closure during sleep. Once poor lid seal has been diagnosed, appropriate treatment can be given, as shown in the stated case study. The Korb-Blackie light test is a simple method for detecting poor nocturnal lagophthalmos and should be used to evaluate patients with dry eye.
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