Sleeping With Your Eyes Open Causes Risks And Treatment

Sleeping with your eyes partially or fully open may sound like a myth, but it’s a real condition known as nocturnal lagophthalmos. Affecting up to 20% of people, this phenomenon can lead to serious eye complications if left unaddressed. While some individuals experience only mild discomfort, others face chronic dryness, corneal abrasions, or even vision loss. Understanding the causes, recognizing symptoms early, and knowing how to treat it are essential for preserving eye health and ensuring restful sleep.

What Is Nocturnal Lagophthalmos?

Nocturnal lagophthalmos is the inability to fully close the eyelids during sleep. The degree varies—some people have only a small gap, while others sleep with their eyes noticeably open. This condition disrupts the natural protective function of blinking and eyelid closure, which normally keeps the eyes lubricated and shielded from debris and light.

The root cause often lies in facial nerve dysfunction, muscle weakness, or structural issues around the eyelids. It can also be associated with medical conditions such as Bell’s palsy, stroke, thyroid-related eye disease, or trauma to the facial nerves. In some cases, genetics play a role, especially when there's a family history of incomplete eyelid closure.

“Patients who sleep with their eyes open are at risk of significant ocular surface damage due to exposure. Early diagnosis and protection are critical.” — Dr. Lena Patel, Ophthalmologist and Cornea Specialist

Risks and Complications of Open-Eye Sleep

Leaving the eyes exposed overnight prevents them from receiving the moisture and protection they need. Without full eyelid coverage, the tear film evaporates quickly, leading to dryness and irritation. Over time, this can escalate into more severe problems:

• Dry Eye Syndrome: Persistent dryness causes burning, itching, and a gritty sensation.
• Corneal Abrasions: The exposed cornea is vulnerable to scratches from bedding or dust.
• Corneal Ulcers: Untreated abrasions can become infected, forming ulcers that threaten vision.
• Photophobia: Increased sensitivity to light due to surface inflammation.
• Blurry Vision: Irregular tear distribution affects visual clarity upon waking.
• Chronic Redness and Inflammation: Long-term exposure leads to conjunctivitis and eyelid swelling.

Tip: If you wake up with sore, dry, or red eyes regularly, consider nocturnal lagophthalmos as a possible cause—even if you don’t remember seeing your eyes open.

Diagnosis and Medical Evaluation

Diagnosing nocturnal lagophthalmos typically begins with a patient history and physical examination. Doctors may ask bed partners if they’ve noticed the person sleeping with their eyes open. A simple clinical test involves measuring the distance between the upper and lower eyelids during attempted closure.

Ophthalmologists may perform additional assessments:

1. Slit-lamp exam: To inspect the cornea for signs of dryness or damage.
2. Tear breakup time (TBUT): Measures how quickly tears evaporate from the eye surface.
3. Schirmer’s test: Evaluates tear production levels.
4. Lid tension tests: Assesses the elasticity and function of eyelid muscles.

In complex cases, imaging or nerve conduction studies may be used to evaluate facial nerve integrity, especially if paralysis or neurological conditions are suspected.

Treatment Options and Management Strategies

Treatment depends on severity and underlying causes. Mild cases may require only lifestyle adjustments and nighttime protection, while severe cases might need surgical intervention.

Treatment Type	Description	Effectiveness
Artificial Tears & Ointments	Lubricating eye drops or thick gels applied before bed	High for mild cases
Eyelid Weights	Tiny gold or platinum implants help close eyelids	Moderate to high
Moisture Chambers	Goggles that trap humidity around the eyes	Effective for moderate dryness
Taping Eyelids Shut	Hypoallergenic tape gently holds lids closed	Short-term relief
Surgery (e.g., eyelid implant)	Permanent solution for nerve damage patients	Long-term success in select cases

Step-by-Step Nightly Care Routine

1. Cleanse eyelids: Use a gentle lid scrub to remove debris and prevent infection.
2. Apply lubricating ointment: Use a preservative-free gel like Lacri-Lube before bed.
3. Wear moisture goggles: Brands like Tranquileyes create a sealed environment.
4. Humidify the bedroom: Maintain humidity above 40% to reduce evaporation.
5. Use a bedside shield: Prevent accidental rubbing or pressure on eyes during sleep.

Real-Life Example: Managing Lagophthalmos After Bell’s Palsy

Mark, a 47-year-old teacher, developed Bell’s palsy following a viral infection. While most symptoms resolved within three months, he continued waking up with painful, sandy-feeling eyes. His partner noticed his right eye remained slightly open at night. After visiting an ophthalmologist, Mark was diagnosed with unilateral nocturnal lagophthalmos.

His doctor prescribed a nightly routine: applying thick eye ointment, using hypoallergenic tape to keep the eyelid closed, and wearing moisture chamber goggles. Within two weeks, his morning discomfort decreased significantly. Six months later, after minor surgical placement of a gold eyelid weight, Mark no longer needed tape or ointment and reported improved sleep quality and eye comfort.

Tip: Always use medical-grade, breathable tape designed for sensitive skin—never duct or regular adhesive tape near the eyes.

Prevention and Daily Habits That Help

While some causes of nocturnal lagophthalmos are unavoidable, certain habits can reduce risk or severity:

• Maintain good eyelid hygiene to prevent inflammation.
• Avoid prolonged screen time before bed, which reduces blink rate.
• Stay hydrated to support natural tear production.
• Use a humidifier in dry or air-conditioned bedrooms.
• Protect eyes from wind and dust with wraparound sunglasses during the day.

Checklist: Are You at Risk?

Answer these questions to assess your likelihood of nocturnal lagophthalmos:

• Do you frequently wake up with dry, irritated, or scratchy eyes?
• Has someone told you that your eyes stay open while you sleep?
• Have you had facial nerve injury, Bell’s palsy, or thyroid eye disease?
• Do you wear contact lenses and experience increased discomfort at night?
• Do you snore heavily or sleep with your mouth open (indicative of altered facial tone)?

If you answered yes to two or more, consult an eye care professional for evaluation.

Frequently Asked Questions

Can sleeping with your eyes open cause blindness?

Not directly, but untreated corneal damage from chronic exposure can lead to ulcers, scarring, and permanent vision loss. Early intervention prevents these outcomes.

Is nocturnal lagophthalmos common in children?

Yes, especially in infants under one year old, whose facial muscles are still developing. Most outgrow it by age five. However, persistent cases should be evaluated by a pediatric ophthalmologist.

Are there any home remedies that work?

Home care is part of management—using artificial tears, taping, and humidifiers helps—but it should not replace professional diagnosis. Self-treatment without understanding the cause can delay necessary medical care.

Conclusion: Take Action to Protect Your Eyes

Sleeping with your eyes open isn’t just unusual—it’s a signal that your eyes aren’t getting the protection they need. From dryness to potential corneal damage, the risks are real but manageable. With proper diagnosis and consistent care, most people can relieve symptoms and prevent long-term harm. Whether through lubrication, protective gear, or medical intervention, solutions exist to restore comfort and safeguard vision.

💬 Your eyes deserve protection around the clock. If you suspect you’re sleeping with your eyes open, schedule an eye exam today. Share this article to help others recognize the signs and seek care early.