Am I sleeping with my eyes open?

Do you wake up each morning feeling like there’s sandpaper in your eyes? If so, you could be sleeping with your eyes open.

It may seem like just a weird habit, but it can be dangerous for your eyes if left untreated for a long period of time. Sleeping with your eyes open is medically referred to as nocturnal lagophthalmos. Lagopthalmos is usually caused by problems with the nerves or muscles in the face that make it difficult to keep your eyes fully closed.

You probably won’t know if you sleep with your eyes open unless someone tells you that you do, but if you wake up with dry eye symptoms, such as pain, redness, and blurry vision, it might be a good idea to check in with your doctor.

What are the symptoms?

We blink during the day and shut our eyelids at night for a very good reason. Shutting the eyelid covers the eyeball with a thin layer of tear fluid. Tears help to maintain a moist environment for the cells of the eye to function properly. The tear fluid also helps to flush out dust and debris.

Without proper lubrication, the eye can be damaged, scratched, or become infected. The symptoms of nocturnal lagophthalmos are related to the drying out of the exterior part of the eye.

They may include:

  • redness
  • blurred vision
  • burning
  • irritation
  • scratchiness
  • light sensitivity
  • feeling like something is rubbing against your eye
  • poor quality sleep

Causes of sleeping with your eyes open

Nocturnal lagophthalmos is typically related to a problem with the muscles or nerves of the face. Anything that causes weakness or paralysis in the orbicularis oculi muscle (the muscle that closes the eyelids), can lead to sleeping with the eyes open. Some examples include:

It can also be caused by an infection, including:

Nocturnal lagophthalmos can also be caused by physical damage to the eyelids. Eyelid surgery or scarring from burns or other injuries can damage the eyelid and make it less able to fully close. Bulging or protruding eyes (exophthalmos) caused by Graves’ ophthalmopathy, a condition commonly seen in people with an overactive thyroid gland (hyperthyroidism), can also make it more difficult to close the eyelids.

For some people, sleeping with their eyes open has no apparent cause. It may also run in families. Less commonly, very thick upper and lower eyelashes might prevent someone from being able to fully close their eyes at night.

Visiting your doctor

Your doctor will ask you questions about your medical history. Make sure you tell your doctor about any recent injuries, infections, allergies, or surgeries involving the head, face, or eyes.

At your appointment, your doctor will likely ask you a few questions, such as:

  • How long have you had symptoms?
  • Are your symptoms worse when you wake up? Do they improve throughout the day?
  • Do you use a ceiling fan or other heating or cooling system with air vents at night?
  • Has anyone ever told you that your eyes are partially or fully open when you sleep?

If your doctor suspects you’re sleeping with your eyes open, they may ask you to perform a few tasks in order to observe your eyes while they’re closed. For example, you may be asked to lie down and gently close both eyes, as if you were about to take a nap. Your doctor will observe what happens to your eyelids after a minute or two has passed. They may look to see if the eyelid twitches or opens slightly on its own.

Other tests include:

  • measuring the space between your eyelids with a ruler
  • measuring the amount of force used to close your eyes when you blink
  • a slit lamp exam, where a microscope and bright light are used to look at your eyes
  • a fluorescein eye stain test to see if there are any signs of damage to your eye

What are the complications of sleeping with your eyes open?

Extended dehydration of the eye can lead to serious problems, such as:

  • loss of vision
  • infections in the eye
  • increased risk of injury or scratches to the eye
  • exposure keratopathy (damage to the cornea, the outermost layer of the eye)
  • corneal ulcer (an open sore on the cornea)

How to treat the symptoms caused by sleeping with your eyes open

Your doctor might recommend using moisture googles at night to help moisturize your eyes while you sleep. You can also try a humidifier. An external eyelid weight, which is worn on the outside of your upper eyelids at night, or surgical tape, can help keep your eyes closed.

Medications

To keep the eye lubricated, your doctor might prescribe you medications, such as:

  • eye drops
  • artificial tears, which are administered at least four times per day
  • ophthalmic ointments to prevent scratches

Surgery

In severe cases of paralysis, you may need a gold surgical implant. This eyelid implant functions just like an eyelid weight to help close the upper eyelid, but it’s a more permanent solution.

During the short procedure, your doctor will make a small incision on the outside of your eyelid right above the lashes. The gold implant is inserted in a small pocket in the eyelid and held in position with stitches. The incision is then closed with stitches and an antibiotic ointment is applied to the eyelid.

After the surgery, you may experience some of the following, but they should go away over time:

  • swelling
  • discomfort
  • redness
  • bruising

The eyelid might feel slightly thicker, but the implant is usually not noticeable.

What is the outlook?

Sleeping with your eyes open is usually not serious, and can be managed with simple solutions, like eye drops, lid weights, and humidifiers. However, it can also be a symptom of another condition.

It’s important to visit your doctor if you have trouble closing your eyes to sleep or you notice that your eyes are extremely irritated throughout the day. The best course of action is to treat nocturnal lagopthalmos before it becomes a bigger problem.

Even in severe cases, implant surgery is a safe and effective solution for sleeping with the eyes open. It not only carries a 90 percent success rate, but the implants can be easily removed if needed.