Doctors refer to the condition where people sleep with their eyes open as nocturnal lagophthalmos. A person may wake up with dry or irritated eyes. However, they will not usually experience severe complications, unless left untreated for an extended period.

Up to 5% of people are affected by nocturnal lagophthalmos.

In most cases, eyelids will close most of the way. However, even a small opening in the eyelids can dry out the eyes.

If someone has an issue with their facial nerves or muscles, keeping the eyes fully closed can be difficult. It can also occur due to problems with the skin around the eyelids.

Read on for the ways sleeping with eyes open can affect sleep, causes of nocturnal lagophthalmos, treatment options, diagnosis, and potential complications.

A close-up of a person's eye closedShare on Pinterest
Ahmed Mohamed/EyeEm/Getty Images

When people sleep with their eyes open, it can cause their eyes to dry out. Without enough lubrication, the eyes are more susceptible to infections and can become scratched.

However, a person does not usually experience severe complications or damage to their eyes. If this condition is left untreated for an extended period, the risk of serious damage to the eyes increases and may result in loss of vision.

People may experience the following symptoms:

A person may also report insomnia or worsened symptoms when waking up, morning, or night.

If an individual is not experiencing any noticeable symptoms, someone else may be able to tell them if they sleep with their eyes open. Alternatively, an ophthalmologist or optometrist can perform an eye exam to confirm the diagnosis.

Read more about types of eye doctors.

Research in 2020 associates nocturnal lagophthalmos with reduced sleep quality. A person may not sleep as long or as well due to the pain and discomfort caused by the eyes drying out throughout the night.

People should make an appointment with their doctor or optician if they suspect nocturnal lagophthalmos. A medical professional can then help with the appropriate diagnosis and treatment.

People usually sleep with their eyes open due to an issue relating to the facial muscles, nerves, or skin around the eyelids. A person may also experience this eye condition due to anatomical or behavioral differences.

Medical conditions

Paralysis or weakening of the muscle that closes the eyelids, known as the orbicularis oculi, can cause someone to sleep with their eyes open.

Conditions that can cause muscle weakness or paralysis of the facial nerves include:

Trauma, injury, or surgery of the eye can also result in damage and paralysis to facial muscles and nerves.

Infections

Infections can be less common causes, but these may include:

Anatomical

Exophthalmos — which may result from Graves’ disease — is where the eyes bulge or protrude, known as proptosis. This condition can also make it difficult to close the eyes as there is a larger surface eye area for the eyelid to cover. Other possible causes of proptosis include congenital conditions of the face or a tumor.

Very thick upper or lower eyelashes may also prevent the eyelid from closing completely, though this is rare. For example, this may result from the side effects of medications for glaucoma — a buildup of fluid in the eye — which may contribute to eyelash growth.

Other conditions can either shorten the eyelids or decrease their muscle tone. This can also prevent the eyelids from fully closing. Cosmetic procedures such as eyelid-tightening surgery for droopy eyelids, Botox injection, and fat removal around the eyes may further affect the height and tone of eyelids.

Behavioral

Heavy alcohol ingestion and sedatives, including some sleeping pills, may also cause lagophthalmos to occur.

However, there is not always a reason or underlying condition that causes nocturnal lagophthalmos. It may also be genetic, or a person may be able to keep track of the incidence by taking note of behaviors that occurred before sleeping.

There are several treatment options for nocturnal lagophthalmos. A doctor might prescribe medications, such as artificial tears.

Eye products

A person can also wear moisture goggles at night, which moisturize the eyes during sleep. Alternatively, people may wear an eye mask when sleeping to help improve eye hydration.

A doctor may recommend using an external eyelid weight. This weight attaches to the outside of the upper eyelids to keep them closed. Applying surgical tape to the eyelids also serves the same purpose.

Lifestyle

A person can make certain lifestyle changes that may benefit their eyes. For example, a person should avoid sleeping pills.

Sleeping with a humidifier in the bedroom can also keep the air moist and less likely to dry out the eyes. A person can also move their bed away from dry airflow.

People can also try to make adjustments to their sleeping environment by considering the following factors:

  • Darkness: Too much light reduces melatonin production, a hormone that promotes sleep.
  • Noise: Frequent external noise can disrupt deep sleep.
  • Temperature: People should aim for a room temperature of 60–67°F (15.6–19.4°C) to help induce sleep.
  • Mattress: A comfortable and firm mattress can improve sleep. Read on how to choose the best mattress.

People with nocturnal lagophthalmos may also find it helpful to practice blinking more frequently during the day to ensure eyes have sufficient moisture.

Read more about the science of sleep from our dedicated hub.

Surgery

Another option is surgery, though this is usually only recommended for severe cases.

In one type of surgery, an eye specialist will insert a gold surgical implant into the eyelid. Surgeons make a small incision above the lashes to create a small pocket for the implant. Stitches will hold the implant in place, which seals the pocket.

The implant works like an eyelid weight to keep the eye closed while someone is sleeping.

People can apply antibiotic ointment to the eyelid to help it heal. As a result of the surgery, a person may experience:

  • swelling
  • discomfort
  • redness
  • bruising

These symptoms should reduce over time as the eyelid heals.

Lagophthalmos describes the incomplete or abnormal closure of the eyelids and has similar causes to nocturnal lagophthalmos.

If someone suspects they have this condition both in the day and at night, they should consult their doctor.

A doctor will ask whether any recent trauma or illness could be the cause, how long symptoms have been apparent, and when symptoms are at their worst.

If a doctor believes nocturnal lagophthalmos is the cause, they will check what happens to the eyelids after they close. They will observe the eyes for a few minutes to determine whether the eyelids begin to twitch or open.

Other tests a doctor may perform can include:

  • measuring the space between the eyelids
  • measuring the amount of force used to close the eyes when blinking
  • a slit lamp exam, using a microscope and bright light to examine the eyes
  • a fluorescein eye stain test to see if the eye is damaged

It is possible that serious problems may occur if the eyes become dry or dehydrated. These include:

  • vision loss
  • eye infections
  • risk of scratching the eye
  • exposure keratopathy, where the outermost layer or cornea is damaged
  • corneal ulcer, where an open sore develops on the cornea

However, generally, people will not experience serious complications due to sleeping with their eyes open. They may only experience damage to their eyes if the condition is left untreated in the long term.

People who sleep with their eyes open do not usually experience severe complications or damage to their eyes. However, if left untreated for an extended period, the risk of serious damage to the eyes increases and may result in loss of vision.

Treatment for sleeping with the eyes open is usually straightforward, and eye drops, eyelid weights, and air humidifiers can all help.

In some cases, nocturnal lagophthalmos is a sign of an underlying condition. People who suspect they are sleeping with their eyes open should contact their doctor to rule out a more significant problem and receive prompt treatment.