![]() observed that nocturnal lagophthalmos was common in people of the Amharic race in Ethiopia, and some of these developed inferior corneal scarring possibly related to this. Nocturnal lagophthalmos with the eyes partly open during sleep is a fairly common phenomenon, frequently observed in normal individuals. Blink frequency and quality were also observed on the slit lamp and if the patient did not achieve full closure whilst blinking, this was considered as a positive indication of nocturnal lagophthalmos. The examination for nocturnal lagophthalmos involved asking the patient to close their eyes as if they were asleep and the lid position was evaluated after approximately 30 sec on the slit lamp using a very fine slit beam. During the latter, the ophthalmologist documented the presence or absence of corneal epitheliopathy, Bell’s phenomenon and lagophthalmos. The ophthalmologist performed a Schirmer’s test followed by slit lamp examination. An ophthalmologist who was blinded to the questionnaire results examined the patients. more than 50% of the time) and whether they sleep in a high airflow environment (bedroom air conditioning or ceiling/table fan). This asked about the patient’s dry eye symptoms and whether these were asymmetrical which is the patient’s preferred dependent sleeping side if any (i.e. Patients were asked to complete specifically designed questionnaire. Patients who also had established lagophthalmos or had well known risk factors for this (any prior upper eyelid surgery, facial nerve palsy or myopathy and thyroid orbitopathy) were also excluded. Sjogren’s syndrome) or who were using topical or systemic therapy for dry eye were not included. Patients with pre-existing ocular history, relevant systemic history (e.g. Prospective data collection was performed on consecutive new patients visiting the dry eye clinic over a three-week period in May 2013. Institutional review board approval was obtained prior to commencing the study. The study was conducted in accordance to the tenets of the Declaration of Helsinki. It is also of particular relevance in countries, such as the United Arab Emirates where the study is set, where the majority of individuals spend most of the year sleeping in a high air flow environment. Consequently the authors proposed that sleep position may result in an asymmetrical impact on the ocular surface potentially due to differential exposure to circulating room air currents.Īwareness of such potential ocular surface asymmetry based on sleep position and air flow may help explain asymmetry in symptoms and may also help use targeted interventions to help improve the ocular surface. 3 High airflow in the room, such as in an air-conditioned room or in the presence of a ceiling or table fan, can increase the extent of moisture loss from our eyes and result in exacerbation of the already relatively dry ocular surface during sleep. 1, 2 It is also known that tear composition changes during sleep with a state akin to subclinical inflammation. ![]() There is considerable evidence that tear production is reduced during sleep and that the eye is in a relatively dry state. This can occasionally lead to symptoms and signs. In some individuals, the eyes may remain partly open during some parts of the sleep cycle (physiological lagophthalmos). The act of sleeping involves closing our eyes. We spend almost a third of our life sleeping. ![]()
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