![]() In clinical practice, a common scenario involves a patient complaining about ocular discomfort with no obvious cause. ![]() However, more subtle forms (such as lid seal deficiency occurring in patients with normal lid configurations) are frequently overlooked. 1,2ĭiagnosing NL NL is easily recognized when a patient presents with significant lid deformities. It is difficult to successfully treat any dry eye condition if NL is not effectively managed.Ĭommon triggers for NL include cosmetic surgical procedures, Botox (onabotulinumtoxinA injection, Allergan), Grave’s disease, floppy eyelid syndrome associated with sleep apnea and keratoconus, high axial myopia, lid deformities, age-related lid laxity, senile ectropion, and dermatochalasis. NL should be proactively investigated and addressed as, from my experience, it can greatly exacerbate other forms of dry eye (such as aqueous-deficient, Bell’s palsy, medication-induced, etc.). ![]() The problems associated with NL manifest similarly to those from inadequate blinking during the day or prolonged screen use: namely, symptoms of dryness and irritation due to enhanced tear film evaporation, with ensuing ocular surface inflammation. Nocturnal lagophthalmos (NL) describes incomplete eyelid closure during sleep. Once poor lid seal has been diagnosed, appropriate treatment can be given, as shown in the stated case study. The Korb-Blackie light test is a simple method for detecting poor nocturnal lagophthalmos and should be used to evaluate patients with dry eye.
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