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What causes the inability to close the eyes while sleeping?

Nov 18, 2025 Source: Cainiu Health
Dr. Wang Lei
Introduction
Inability to close the eyes during sleep may be caused by improper sleeping posture, eyelid laxity, facial nerve paralysis, thyroid-associated ophthalmopathy, or congenital eyelid closure insufficiency. It is recommended to seek medical attention promptly, identify the underlying cause, and receive symptomatic treatment under a doctor's guidance. During sleep, wearing a moisture chamber eye mask can help protect the ocular surface and prevent dry eyes. Avoid rubbing the eyes to reduce the risk of eye infections.

Under normal circumstances, the inability to close the eyes during sleep may be caused by improper sleeping posture, eyelid laxity, facial nerve paralysis, thyroid-associated ophthalmopathy, or congenital lagophthalmos. It is recommended to seek medical attention promptly, identify the underlying cause, and receive symptomatic treatment under a doctor's guidance. Specific analyses are as follows:

1. Improper sleeping posture: Habitual prone or side-lying positions can exert pressure on the eyes, preventing the eyelids from closing naturally. Adjusting to a supine position or ensuring the eye does not press tightly against the pillow when lying on one's side, along with using a soft pillow of appropriate height, can reduce ocular pressure.

2. Eyelid laxity: Common in older adults, this condition results from decreased elasticity of the eyelid skin, leading to insufficient closure strength. Applying a warm towel compress to the eyes for 5 minutes daily and gently massaging the eyelids may improve firmness. In severe cases, blepharoplasty can be performed to enhance eyelid closure function.

3. Facial nerve paralysis: Caused by viral infection or exposure to cold, resulting in damage to the facial nerve and weakness of the eyelid muscles. Follow medical advice to take medications such as mecobalamin tablets, vitamin B1 tablets, and dexamethasone tablets, combined with acupuncture therapy to promote recovery of nerve function.

4. Thyroid-associated ophthalmopathy: Abnormal thyroid function leads to extraocular muscle enlargement and proptosis (bulging eyes), preventing the eyelids from fully covering the eyeball. First, follow medical instructions to control thyroid function using medications such as propylthiouracil tablets, methimazole tablets, and propranolol tablets. In severe cases, orbital decompression surgery may be required to relieve proptosis.

5. Congenital lagophthalmos: A developmental abnormality of eyelid structure present from birth, causing gaps when attempting to close the eyes. In childhood, eyelid functional exercises may help improve the condition; in adulthood, surgical correction of the eyelid is needed to restore proper structure and achieve complete closure.

During sleep, wearing a moisture chamber goggles can protect the ocular surface and prevent dryness. Avoid rubbing the eyes to prevent infections. Include foods rich in vitamin B complex—such as legumes and nuts—in your diet to support nerve and eyelid muscle health.

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