The eye does not close
A gap remains between the eyelids when you close your eyes or sleep - this is noticed by relatives.
CONDITION / FACE
Lagophthalmos: non-closing of the eyelids.
Lagophthalmos is a condition in which the eyelids do not close completely and part of the eye remains open, even in sleep. It is caused by paralysis of the facial nerve or eyelid surgery, including blepharoplasty. The main task is to protect the cornea, and if the eyelids do not recover by themselves, they are corrected by surgery.
CONCEPTUAL VISUALIZATION- What it is
- The eyelids do not close, and part of the eye remains open.
- What is dangerous?
- The cornea dries up: inflammation, ulceration, in severe cases - loss of vision.
- Causes
- Facial nerve paralysis or eyelid surgery, including blepharoplasty.
- Who treats it
- Cornea - ophthalmologist; eyelids - a surgeon who operates on the eyelids.
01 / WHAT IS ITWhat is
What is
lagophthalmos
When we blink and sleep, the eyelids tightly close the eye and distribute tears over its surface. With lagophthalmos, they do not close completely, and the strip of the eye remains open. The cornea - the transparent front membrane of the eye - dries out.
An unprotected eye is at risk: inflammation of the cornea (keratitis), corneal ulcers, and in severe cases, loss of vision are more common. It happens that lagophthalmos is noticeable only at night, and a person learns about it from the feeling of sand in the eye in the morning.
The main cause is paralysis of the facial nerve, when the muscle that closes the eye does not work. Another reason is blepharoplasty: if too much skin is removed from the upper eyelid, it no longer reaches the lower one. It is about these two reasons.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
lagophthalmos presents.
Eyelids not closing can be seen in the mirror, but more often the person is bothered by the eye itself.
Dryness and sand
Feeling of sand or a foreign body, burning, especially in the morning.
Redness
The eye is red, irritated, hurts from wind or light.
Lacrimation
The eye may water: with paralysis, there are usually several reasons, in particular, a drooping lower eyelid.
EctropionThe lower eyelid drooped
Between the edge of the eyelid and the cornea, a strip of protein is visible - "round eyes".
Inversion and retraction of the eyelid03 / REASONSWhy eyelids?
Why eyelids?
do not close.
The cause depends on whether lagophthalmos will pass by itself and what to do if not.
Paralysis of the facial nerve
The circular muscle of the eye, which closes the eyelids, does not work. Most often it is Bell's palsy; other causes are injuries, tumors and their removal, infections.
Paralysis of the facial nerveBlepharoplasty
A slight lack of closure immediately after surgery is a common phenomenon; usually it passes in 7 days. It lasts longer if the skin of the upper eyelid is missing.
Unsatisfactory result of blepharoplastyExcision of a muscle
According to a review of 12 randomized trials (450 patients), lagophthalmos is more likely to occur when a strip of muscle is excised along with the skin of the upper eyelid.
Lower eyelid
A drooping or pulled-down lower eyelid enlarges the open part of the eye.
Retraction of the eyelid
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Long-standing lagophthalmos usually does not require emergency care, but the eye must be protected every day. Sudden facial distortion can be a sign of a stroke, and some symptoms after eyelid surgery require immediate attention.
103 immediately if:
- the face suddenly tilted to one side - the corner of the mouth or eyelid dropped;
- speech suddenly became slurred or confused;
- suddenly worsened or disappeared vision;
- after surgery on the eyelids - severe or growing pain in or around the eye;
- after surgery on the eyelids, the eye protrudes or became tense;
- after eyelid surgery, the eyelids do not open;
- after surgery, double vision appeared on the eyelids.
Do not delay a visit to the doctor:
Immediately - to the reception or to the ophthalmologist on duty: the eye is red and your vision has changed (blurry, flashes or wavy lines) or it hurts to look at the light. On the same day: to an ophthalmologist if the eye hurts a lot and is red: this may be a sign of corneal damage. On the same day to the doctor - and if the face has weakened in a few days, and a stroke has been ruled out: medicines for Bell's palsy work better in the first 72 hours. In the coming days: after blepharoplasty, the eye does not close for more than a week - tell the surgeon who operated. Planned: lagophthalmos lasts for months, the eye has to be glued at night.
05 / DIAGNOSTICSAs defined,
As defined,
which interferes with the eyelids.
- Conversation
When the eyelids stopped closing: after surgery, after paralysis or gradually; what operations on the eyelids were done.
- Examination of the eyelids
How wide is the gap when you close your eyes, is there enough skin in the upper eyelid where the lower one is.
- Eye examination
The ophthalmologist evaluates the cornea, tears and sensitivity of the eye under a microscope (slit lamp).
- The face
In case of paralysis, is there a chance that the nerve will recover: it depends on whether to choose temporary or permanent treatment.
06 / TREATMENTHow we treat
How we treat
lagophthalmos
First, they protect the cornea. Then everything depends on whether the eyelids will recover by themselves: if so, temporary means are enough, if not, an operation is required.
01
Eye protection
Every day until the eyelids close.
- Drops and ointment
- Moisturizing drops during the day, ointment at night so that the cornea does not dry out.
- Plaster for the night
- The eyelids are sealed with a special plaster while sleeping; the doctor will show you how.
- Scleral lens
- If the cornea does not heal, the ophthalmologist can choose a special lens.
02
Temporarily
If the nerve is likely to recover.
- Hyaluronic acid
- The gel is injected into the upper eyelid to make it heavier. In a study of 26 patients with temporary nonblinking paralysis, the average reduction was 4.6 mm; the gel gradually dissolves.
03
Surgery
If lagophthalmos does not go away.
- Load in the upper eyelid
- A thin gold or platinum plate is sewn under the skin of the eyelid, and the eyelid descends under its own weight. According to a review of 26 studies (1,205 patients), complete or almost complete closure was found in 83–92%.
- Lower eyelid
- It is pulled up and fixed to the outer corner of the eye; if the eyelid is pulled down, as during retraction, a graft is applied.
- Skin of the upper eyelid
- If the skin is missing after blepharoplasty, it is supplemented with a skin transplant. In a series of 20 patients, it protected the cornea and had an acceptable appearance.
- Lipofilling
- Own fat in the upper eyelid is an alternative to fat: a stable effect in 77%, but some patients repeat the procedure.
04
Outcome and risks
- Blinking
- Operations close the eye better, but do not restore normal blinking.
- cargo
- Complications — in 5–15%, most often the load shifts or penetrates through the skin.
- Stitching of the eyelids
- Once the eyelids were sewn together; now they do it only in special cases.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Lagophthalmia at Dr. Valikhnovskyi's Institute of Surgery is treated in the direction of "New Face" - together with paralysis of the facial nerve and the consequences of operations on the eyelids. The clinic performs eyelid surgery; the cornea is examined and treated by an ophthalmologist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Golden loads — the load in the upper eyelid helps it to lower and close the eye in case of paralysis.
- Canthopexy and canthoplasty — strengthen or restore the outer corner of the eye, so that the lower eyelid again fits the eye.
- Lateral tarsal stripe — the drooping lower eyelid is shortened and fixed to the outer corner of the eye.
- Transplants and spacers — when the eyelid lacks skin or support, the deficiency is filled with a graft or a spacer.
- Repeat blepharoplasty — correction of the consequences of previous surgery on the eyelids, in particular in another clinic.
- Static operations for paralysis — with long-term paralysis of the facial nerve, the symmetry of the face at rest is improved.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
Publications by topic
- "The effectiveness of static reconstructive methods in the treatment of long-term paralysis of the facial nerve" — Hospital Surgery, 2025 (DOI).
How treatment works with us
- Photo onlineSend a photo of your eyes directly, as well as with your eyes closed - the doctor will assess the situation in advance.
- ConsultationExamination of the eyelids and face, finding out the cause; the condition of the cornea is assessed by an ophthalmologist.
- PlanTemporary protection or surgery, on which eyelid and in what sequence.
- SurgeryTechniques are chosen according to the reason; often combine operations on the upper and lower eyelids.
- RecoveryThe first days — swelling; drops and ointment continue until the doctor says otherwise.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Will lagophthalmos go away after blepharoplasty?
A slight inability to blink immediately after surgery usually goes away within a week. If it lasts longer, tell the surgeon that the skin may be missing and a skin graft may help.
What is dangerous if the eye does not close at night?
The cornea dries up. This increases the risk of inflammation and ulceration of the cornea, and in severe cases, loss of vision. Therefore, the eye is protected with drops, ointment and patch.
What is a gold cargo?
A thin plate of gold or platinum that is sewn into the upper eyelid. The eyelid becomes heavier and droops when the muscle is not working. According to a review of studies, closure is complete or nearly complete in 83–92%.
Is it possible to do without surgery?
If the nerve is likely to recover, yes: drops, ointment, plaster, sometimes hyaluronic acid in the upper eyelid. If the paralysis is prolonged, surgery is usually required.
Will the blinking come back after surgery?
Not at all: operations help to close the eye, but do not restore normal blinking.
I was operated on in another clinic. Can it be fixed?
Yes, the doctor evaluates the eyelids and the eye now and makes a plan regardless of where the first surgery was.
Who is needed - an ophthalmologist or a surgeon?
Both. An ophthalmologist evaluates and treats the cornea, a surgeon corrects the position of the eyelids.
Sources
16 sources · guidelines, systematic reviews, research, NHS and author articleshowCollapse
- Lagophthalmos after facial palsy: current therapeutic optionsOphthalmic Research, 2014doi:10.1159/000365519 ↗
- Nocturnal lagophthalmos: an overview and classificationThe Ocular Surface, 2006doi:10.1016/s1542-0124(12)70263-x ↗
- Clinical practice guideline: Bell's palsyOtolaryngology–Head and Neck Surgery, 2013doi:10.1177/0194599813505967 ↗
- Periocular Reconstruction in Patients with Facial ParalysisOtolaryngologic Clinics of North America, 2016doi:10.1016/j.otc.2015.10.011 ↗
- Management of the Eye in Facial ParalysisFacial Plastic Surgery Clinics of North America, 2016doi:10.1016/j.fsc.2015.09.003 ↗
- Controversies in periocular reconstruction for facial nerve palsyCurrent Opinion in Ophthalmology, 2018doi:10.1097/ICU.0000000000000510 ↗
- Upper Eyelid Static Surgical Approaches for the Treatment of Facial Palsy-Induced Lagophthalmos: A Systematic ReviewJournal of Clinical Medicine, 2025doi:10.3390/jcm14134688 ↗
- Hyaluronic acid gel weight: a nonsurgical option for the management of paralytic lagophthalmosThe Laryngoscope, 2013doi:10.1002/lary.23936 ↗
- MOC-PSSM CME article: BlepharoplastyPlastic and Reconstructive Surgery, 2008doi:10.1097/01.prs.0000294667.93660.8b ↗
- Functional and Aesthetic Outcomes After Upper Blepharoplasty: A Systematic Review and Meta-analysis of Randomized Control TrialsAesthetic Surgery Journal, 2025doi:10.1093/asj/sjaf022 ↗
- The evaluation of the skin-muscle and only-skin upper blepharoplasty featuring surface electromyography: a single-masked, randomized split-face prospective studyInternational Ophthalmology, 2023doi:10.1007/s10792-023-02801-3 ↗
- Upper eyelid skin grafting: an effective treatment for lagophthalmos following blepharoplastyPlastic and Reconstructive Surgery, 2003doi:10.1097/01.PRS.0000081477.02812.C9 ↗
- Bell's palsyNHS, 2023nhs.uk/conditions/bells-palsy ↗
- Red eyeNHS, 2025nhs.uk/symptoms/red-eye ↗
- Eyelid surgeryNHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/eyelid-surgery ↗
- Effectiveness of static reconstructive methods in the treatment of long-term paralysis of the facial nerveHospital surgery. Magazine named after L. Ya. Kovalchuk, 2025doi:10.11603/2414-4533.2025.3.15623 ↗
The figures on the page are from these sources.
The eye does not close
completely?
Send a photo of your eyes, especially with your eyes closed. The doctor will tell you what prevents the eyelids from closing and how to fix it.