Nocturnal Lagophthalmos

The frequency of severe corneal opacities in premature infants

PURPOSE

To study the frequency and possible causes of severe corneal opacities in premature infants undergoing retinopathy of prematurity (ROP) screening in the neonatal intensive care unit (NICU) at a single institution.

METHODS

The medical records of all infants screened for ROP in the NICU between January 2015 and March 2019 were reviewed retrospectively. Criteria for screening were gestational age (GA) of <32 weeks or birth weight (BW) <1501 g. Characteristics of premature infants with severe corneal opacities were extracted from the record.

RESULTS

A total of 445 premature infants were screened during the 51-month period. The prevalence of severe corneal opacities was 1.4% (6 infants). The median GA of the affected infants was 24.5 weeks (range, 23-32), and the mean BW was 624 g (range, 500-860 g). Two infants had lagophthalmos; their corneal opacity was unilateral. All the infants were under continuous positive airway pressure (CPAP) for a prolonged period. All 4 infants with bilateral corneal opacities required treatment for severe ROP-laser (n =1), bevacizumab injection (n = 1), or both (n = 2).

CONCLUSIONS

Severe corneal opacities in premature infants are rare but potentially sight threatening, because they can hinder the retinal examination. Lagophthalmos-related exposure keratopathy is an obvious risk factor. CPAP therapy may be another risk factor leading to the development of severe corneal opacities. Identification of infants at risk and prompt commencement of lubricants is necessary to avoid long-term corneal opacities.

Nocturnal Lagophthalmos and Sleep Quality in Patients with Dry Eye Disease

Nocturnal lagophthalmos (NL) refers to the inability to close the eyelids during sleep, which is known to affect dry eye disease (DED) symptoms and sleep quality. This study aimed to evaluate the prevalence of NL and sleep quality in DED patients. We launched a survey website to recruit 2000 Japanese. The participants were asked to answer a questionnaire about DED, sleep quality, and happiness. Participants were divided into two groups according to the presence of DED, and responses were compared between the groups. The DED group was comprised of 890 subjects (44 ± 13.8 years, 359 males) and women were predominant (p < 0.001). Sleep duration was significantly shorter (p = 0.008), sleep latency was longer (p < 0.001), and sleep efficacy was worse compared with the non-DED group (p < 0.001). Furthermore, people belonging to the DED group were more frequently working night shifts (p < 0.001). NL was more prevalent in the DED group (p = 0.007). Logistic regression analysis showed that NL correlated with younger age, symptomatic DED, and eye symptoms upon waking. The current study suggested that NL was associated with worsened DED symptoms and poor sleep quality. Preventative eye care for lagophthalmos before and during sleep may be helpful for DED and sleep quality.