I can't close my eyelid!!!
Lagophthalmos is a condition whereby one is unable to close the eyelid completely. It can be seen in a variety of conditions involving the facial nerve or eyelid itself. The common causes involving facial nerve is trauma, stroke or tumor. However, more commonly lagophthalmos is due trauma to the eyelids which form cicatrix, or after eyelid surgery whereby excessive eyelid skin has been removed. Lagophthalmos can also be seen in certain patients with prominent eyes such as Thyroid Eye Disease or high myopia. This condition may appear inconsequential but can be detrimental in the long run. Constant eye exposure to the air may dry the eye which leads to dryness, discomfort, foreign body sensation and reflex tearing.
The patient above sustained a full thickness eyelid laceration 2 years ago. She developed a notched eyelid margin and a contraction band that pulled the eyelid upwards causing lagophthalmos. She has been having tremendous discomfort and unable to sleep at night due to chronic exposure. The definitive treatment for such condition is a reconstructive surgery. The eyelid margin needs to be reconstructed to yield a smooth alignment. The contraction band can be released by means of a Z-plasty. However, she has limited time in Malaysia and wanted a minimally invasive approach. I subcised the scar band with 21G needle and stented with hyaluronic acid gel filler. A few days later, I injected 5FU into the subcised scar band. She felt much more comfortable now and she told me she managed to sleep through the night, which she couldn't do in a long time. This is not the definitive treatment but may help her to buy time while she arranges for the next visit to Malaysia for reconstructive surgery.
