Lagophthalmos in Severe Anorexia Nervosa: A Case Series
Anorexia nervosa is characterized in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) by (1) a refusal to maintain a minimally normal body weight (eg, a body weight of <85% of expected body weight or a body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] of <17.5), (2) an intense fear of gaining weight, (3) a disturbance in the evaluation of one's own body shape, and (4) amenorrhea.1 Anorexia nervosa has the highest mortality of any psychiatric illness and has a lifetime estimated prevalence of 0.9% in women and 0.3% in men, with a standardized mortality ratio of 45 for patients whose lifetime nadir BMI is less than 10.5.2,3 A subset of patients with anorexia nervosa develop such severe disease that they require medical hospitalization for stabilization before they are able to be admitted to traditional eating disorder programs. The ACUTE Center for Eating Disorders at Denver Health in Colorado is an inpatient unit with multidisciplinary expertise in caring for such critically ill patients.
We describe 5 patients with severe anorexia nervosa who were admitted to the ACUTE Center and who complained of dry, irritated eyes and photophobia. Examination revealed lagophthalmos in the setting of enophthalmos and pseudoptosis with a narrowed palpebral fissure, with multiple other starvation-mediated medical complications. Protective measures, including the use of sterile topical ophthalmic ointment and taping shut the eyelids every night, with the use of topical lubrication during the day, in addition to volume repletion and modest weight restoration, resolved both the lagophthalmos and the secondary ocular exposure symptoms. We will describe 1 case in detail and make mention of the other 4 cases.