The surface of the eyes is constantly moistened with the help of a full and correct closure of the eyelid and a full blink.
This is the protection of the cornea and the eye as a whole. But with the impossibility of complete closing of the eyelids, this protection is lost. There is a violation of the integrity of the tear film and pathological changes in the conjunctiva and the cornea.
Incomplete closure of the eyelids is called a lagophthalmus. In this disease, even during sleep, the eye gap does not close completely or partially. Another name for this ailment is the "hare eye".
- 1. The concept of the lagophalm
- 2. The healing strategy
- 3. Preventive measures
The concept of the lagophthalmus
This ophthalmic disease is characterized by incomplete closure of the eye due to non-closure of the eyelids.
What causes the disease
The causes of the development of the disease are:
- facial nerve paralysis,
- congenital eyelid shortness,
- eyelid eversion( after injuries and operations on the eyes),
Often, scar processes on the skin of the eyelids and face lead to lagophthalmus.
Incomplete closing of the eye is caused by a strong protrusion of the eyeball( or exophthalmos).This state develops due to orbital processes, for example, when the tumor grows behind the eye. It is also possible if thyroid activity is impaired.
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The cause of insufficient closure of the eyelids may be an increase in the eyeball( with a strong myopia or bullish eye).
Lagophthalmus can also develop as a result of the growth of the eyelid to the conjunctiva of the eyeball( simbelfarone).Cases of innate origin of this phenomenon are known. But more often it is the result of injuries as a result of mechanical damage( mainly burns).
Other causes of this fusion may be:
- trachoma,
- pemphigus( blistering of conjunctiva and skin of eyelids),
- avitaminosis A.
Aggravating factors
The facial nerve can have an innate lesion or idiopathic( Bell's paralysis).
This condition can provoke:
- influenza,
- hypothermia,
- central nervous system diseases( aortic aneurysm, stroke),
- facial and skull injuries,
- ear disease,
- inflammation of the salivary gland near the ear( inflammation passes to the nerve),
- infectious diseases,
- meningitis.
The main manifestations of the disease
At the outset of the disease may appear:
- reddening of the eyes( especially after sleep),
- dry eyes,
- burning in the eye and foreign body sensation,
- photophobia,
- deterioration or blurring of vision,
- discomfort or pain ineyes.
Easily observed symptoms of the disease:
- markedly wider eyepiece in the lesion,
- lower eyelid lowering and its retardation from the eyeball,
- lacrimation( since the lower eyelid and teardrop is turned out).
As a result, the cornea and conjunctiva dry out, causing:
- erosion,
- corneal ulceration( keratitis),
- corneal opacity.
Types of lagophthalm and its diagnosis
The degree of severity of the disease may be weak, moderate and severe. In very severe and neglected cases, it can cause loss of vision and even loss of the eye.
There are people with an incompletely closed eye, which have no pathological causes. Such a lagophthalmus is called physiological. A person does not experience discomfort and does not even know about his illness until his relatives tell him.
This disease is easy to recognize. It is noticeable as a cosmetic defect in the face. Diagnosis is based on clinical signs. The purpose of differential diagnosis is to check for eyelid eversion.
A full neurological examination is helpful to clarify the diagnosis. If necessary, use instrumental methods of research, in particular, ENM( electroneuromyography).With its help, the speed of the pulse along the fibers of the facial nerve is determined.
Therapeutic strategy
Therapy of major diseases
The type of treatment is determined by the root cause of the development of the lagophthalmus. If this is a paralysis of the facial nerve, then the therapy is performed by a neurologist with constant interaction with the ophthalmologist.
Treatment of inflammatory diseases and stroke usually gives good results. It is important to eliminate the causes that caused exophthalmos, and also to treat the eversion of the eyelids.
Drugs
At the beginning of the disease, local therapy is performed to moisten the cornea.
Disinfecting drops are instilled in the eye:
- sodium sulfacyl 30%,
- furacilin solution 0.02%,
- "Artificial tear".
To reduce lacrimation, the eyelid pulling of the eyelid is done. One of the modern preparations for moistening the cornea and its protection is "Defislis".
Principles of care for a patient with this disease are based on the prevention of eyes from severe drying and infection.
Surgical intervention
When lagophthalmus takes on severe forms, it is resorted to surgical intervention. It consists in the selection of the following types of operations:
- installation in the upper eyelid implant,
- plastic eye gap,
- hanging lower eyelid,
- elimination of scar pathology,
- introduction of silicone thread along the entire length of the eyelid,
- manipulation on the upper muscle involved in raising the eyelid(from internal soldering to outer).
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During the recovery period, a course of sanatorium treatment in a sanatorium with a medical profile is desirable. LFK has great importance in rehabilitation.
Preventative measures
Use of folk remedies
To prevent the eye from drying out and prevent infection, the eye is placed in the eye before going to sleep:
- ointments with antibiotics,
- Vaseline sterile oil,
- sea buckthorn oil.
Fish oil, thiamine ointment of 0.5% are well proven. Vitamins B1( B6) in the form of injections( subcutaneous) on 1 ml daily are also effective. The standard course is from 10 to 30 introductions.
Prevention of disease
General prevention of lagophthalmia includes:
- timely treatment of eye diseases,
- proper therapy of neuritis of facial nerve,
- eye injury prevention,
- prevention of eye burns.
It is also recommended to use soft contact lenses as protective dressings.
As a rule, the prognosis of treatment is favorable. With acute neuritis of the facial nerve, the lagophthalmus can pass completely. In a persistent disease, surgical treatment usually eliminates the disease, preventing dystrophic keratitis.