May be its too small a thing to ask but please tell me,
1) Why some people sleep with their eyes almost half open
2) Although they have normal bell's yet mostly their cornea is exposed, why?
3) Recently examined a kid- absolutely symptomless- with punctate corneal epitheliopathy
who sleeps like this, should prescribe any lubricants for night time in such case altho i haven't ?
Dr. Charu Arora.
Dear Dr. Charu,
The eyes and the eyelids assume a position of rest while asleep. With resting muscular tone, usually this is enough to close the lids when asleep. when the orbit is small and the eyes a bit protuberant and the lids a bit rigid and short as seen in some children, there can be scleral or corneal show. reg asymptomatic spk in a kid, i would check the corneal sensation and if it is normal and the kid has been like this for several years without scarring or vascularization, would probable observe once in a while. The exact reverse of this i think, happens in post op patients with deep set eyes. the wire speculum stretches the ligaments and muscles of the upper lid and causes post op ptosis.
with best wishes,
Dear Dr.Charu Arora,
This is avery common condition and most of these patients with ealy morning stinging sensation and watering of the eyes which subsides in about 2 hrs.They usually present with inf limbal punctate epitheliopathy with vascularization.They do very well with night application of lubricants which needs to be continued for along time.You will notice that in these patients the lower lid is sinuous and dips down laterally. This if i am right is know as euryblepheron.
You have highlighted a common yet interesting observation.
1) Why some people sleep with their eyes almost half open: Physiological noctural lagophthalmos can be familial and related to various factors including cephalometric disproportion to the globe, borderline eyelid tone, malar hypoplasia with lower eyelid descent. Ofcourse when unilateral, a partially recovered Bell's palsy should be kept in mind. Interestingly in these patients when you assess orbicularis function, it may appear normal.
2) Although they have normal bell's yet mostly their cornea is exposed, why? Do remember Bell's phenomenon is usually an upward and outward rotation of the eyeball in RESPONSE TO VOLUNTARY CLOSURE. Hence , there is no active Bell's phenomenon in deep sleep, only initially. For the same reason, Bell's phenomenon is not a very protective feature following congenital ptosis correction in sleep - only during the day time upon voluntary blinking and closure of the eyes.
3) Recently examined a kid- absolutely symptomless- with punctate corneal epitheliopathy who sleeps like this, should prescribe any lubricants for night time in such case altho i haven't ? If symptomatic or if asymptomatic keratopathy is present, lubricants may be justified. Ofcourse other general measures like avoiding airconditioning (environmental dehydration), fans blasting onto the face directly,e tc may also have some benefit. Recently, lid weighting technique has been described by Raman Malhotra and group for related condition in symptomatic patients.
Dr Gangadhara Sundar