Nocturnal lagophthalmos also called free#
Clean the masks every morning in a simple soap that is free of perfumes, triclosan and colorants (such as diluted Dr Bronner’s soap). Some MGD patients report improved symptoms with night mask wear particularly if there is a component of allergy to dust mites. My patients report that the mask helps them sleep better and that their morning symptom severity is reduced.
By creating a comfortable seal around the periocular region, moist protection of the ocular surface is recreated. However, for patients with moderate or severe signs and symptoms, I use a silicone medical-grade vaulted sleep mask developed for dry eye and MGD patients (such as eyeseals, Eye Eco), and specially designed to work with CPAP devices. If a patient’s lid seal insufficiency and dry eye signs/symptoms are mild, I may advise them to use preservative-free OTC lubricating gels and ointments. Treatment of OSA with CPAP has been reported to result in improvements in FES (10) and this is consistent with our clinical observations. One common theory is that the hypoxic episodes associated with obstructive sleep apnea create a smoldering inflammation which, over time, destroys the elastin fibers (8) and collagen fibers of the eyelids thereby creating the lid laxity, lash ptosis, and papillary conjunctivitis characteristic of FES (9).
Nocturnal lagophthalmos also called series#
Additionally, a post-surgical FES repair tissue analysis series demonstrated very high amounts of metalloproteinases in the tissues. Ischemic damage is well described in obstructive sleep apnea and is associated with chronic inflammation. Recent research suggests that floppy eyelids are associated with physical influences introduced over time: specifically, sleeping preferences – even face-down may exert tractional forces on the eyelid(s) (7). The pathophysiology of FES is interesting and multifactorial. In severe cases of FES, surgical repair may be required (6). In these patients, we order a sleep study to identify obstructive sleep apnea (OSA), which is often associated with FES (5). Excessive amounts of upper lid laxity and distractibility from the globe are highly suggestive of floppy eyelid syndrome (FES). We pull on the upper lid superiorly and temporally from the globe (see Figure 2). Lids that snap into place quickly are elastic and likely healthy, while lids that are slow to normalize may indicate excess laxity, functional lid malpositions, abnormal lid wiper mechanics and potentially, insufficient nocturnal lid seal. A snap test is performed by gently pulling the patient’s upper and lower eyelids away from the globe in a pinch like fashion then releasing. We can also use a simple and effective “snap test” to manually assess a patient’s lid position. In our practice, we record this in the EMR as “lid seal insufficiency,” grading the condition negative, mild, moderate or severe based on the amount of light leakage. The more light that “escapes” the interpalpebral fissure, the higher degree of dysfunction and greater exposure to desiccating stress at night (see Figure 1). If light escapes between the eyelids, the patient’s lid seal is inadequate. In a dark room, gently place a muscle light or transilluminator at the upper tarsus of a closed eye and direct the light toward the interpalpebral fissure. The test can be carried out in any exam room with basic equipment. The “Korb-Blackie Lid Leak Test” is a simple and effective way to identify dry eye and MGD patients with insufficient lid seal (3). Proactively addressing this problem is important, as desiccating stress is a known trigger for chronic inflammation leading to chronic dry eye disease (2). When the eyelids’ protective biomechanics are insufficient, they leave the ocular surface exposed at night, and desiccating stress is inevitable without a more specific and robust treatment strategy. For these patients, avoiding fans, allergens and other commonplace aggravators simply isn’t adequate. Given this understanding, it is crucially important that we adjust our diagnostic algorithms to identify dry eye and MGD patients with poor lid functionality – those patients who are particularly susceptible to nocturnal lagophthalmos. Interestingly, patients with asymptomatic dry eye show comparatively and significantly less lid seal failure, and the severity of a patient’s lid performance failure correlates heavily to the degree of dry eye symptom severity observed. Recent research establishes that compromised lid seal – a condition wherein a patient’s eye lids remain partially open during sleep – potentially affects up to 79 percent of all symptomatic dry eye patients across diverse demographic groups (1). It is only by recognizing and minimizing the impact of nocturnal lagophthalmos that a protective ocular surface environment can be recreated.
0 kommentar(er)
