My baby sleeps with her eyes half open. Is that normal?

You look into the cot and your baby is asleep, but her eyes are not shut. There is a thin strip of white showing, or the eyes seem to drift upwards, and you cannot stop watching. Most parents who see this are afraid it means something is wrong, or that her eyes will dry out overnight. Here is what is known, what is not known, and the few signs that should turn watching into a visit.

Is it normal for my baby to sleep with her eyes half open?

It can be, and in a baby who is otherwise well it is often just how her sleep looks. The medical name is nocturnal lagophthalmos, which means the eyelids do not fully close during sleep. A review in the journal Ocular Surface defines it that way, and an eye health site reviewed by an optometrist notes that it may also happen in otherwise healthy people, and that some babies do sleep with their eyes partly open.

It helps to be clear about the limits. Published guidance written for babies does not give a figure for how common it is, or an age when it stops, so this page gives neither. What I can say is that the question that matters is not whether the lids look open, but what the eyes look like and how your baby is when she wakes.

Why do her eyes look like they are rolling or showing white?

Because a baby's sleep is busy, and the lids are not always closed over it. The American Academy of Pediatrics says newborn sleep is divided roughly equally between rapid eye movement (REM) sleep and non-REM sleep, and that in REM sleep the eyes move under the closed lids. If the lids are not quite closed, you can see some of that: a flicker, a drift, a strip of white, or the dark part of the eye slipping up out of view.

You are looking at an eye that is moving normally, seen through a gap. The movement itself is the ordinary part. The gap is the thing to keep an eye on, because it is the gap, not the movement, that could matter for the surface of the eye.

Will her eyes dry out?

This is the sensible worry, and it is the reason doctors ask about it at all. When the lids stay partly open, part of the front of the eye is exposed for hours. The Ocular Surface review points out that a missed gap can lead to damage of the eye surface, which is why a prompt, accurate diagnosis matters. In adults the usual morning complaints are dry, irritated or watery eyes, and a baby cannot tell you any of that.

So you watch the eye instead of the lid. After a sleep in which her eyes were partly open, are they clear, bright and comfortable when she wakes? Then that is reassuring. Are they red, watery, sticky, or is she rubbing them, again and again, on waking? Then it is time for an eye doctor to look, not time for a home remedy.

Will she grow out of it?

Often the way a baby sleeps changes as she grows, but published guidance does not give an age for it. Please be cautious of a web page that says "by six months" or "by eighteen months" as if it were settled. What is more useful than a date is a plan: mention it at her next routine check, and keep an eye on the signs in the next section.

A routine check is also a good moment to ask. When a baby should have a first eye check sets out what is looked at and when, and the doctor can look at how the lids close while she is awake, which a parent cannot judge from a sleeping baby.

When is it worth an eye check?

When the eyes show trouble, or when something else about the face or the lids is different. These are the signs that move this from watching to booking:

• Red, watery or sticky eye on waking. The NHS lists red, sticky, watering eyes as the usual signs of conjunctivitis, and says a baby under 30 days old with red, sticky eyes needs prompt assessment by a GP. For a persistently watery or sticky eye in an older baby, blocked tear ducts are a common and separate cause, and still worth a look.
• Rubbing, squinting or turning away from light after she wakes. These can mean the surface of the eye is sore.
• Lids that do not close when she is awake or crying. A baby who is awake and cannot close the lids fully is not the same as a baby who has a small gap in sleep.
• One side of the face moving less than the other, for example a smile or a cry that is uneven. The NHS lists difficulty closing the eye on the weak side of the face as part of facial weakness, and asks for an urgent GP appointment or NHS 111 if you have symptoms of Bell's palsy.
• Only one eye does it, and there is something else: a drooping lid, a bulging eye or an eye that looks different in size.
• A cloudy or hazy look on the clear front of the eye.

A lid that will not open properly is a different problem again, and I cover it in when a newborn's eyelid will not fully open. This page is about the opposite: lids that do not shut.

Is there ever a bigger cause behind it?

Sometimes, but it is the exception, and it rarely stands alone. A small study of 15 children with a rare inherited condition called urofacial syndrome, which affects the bladder and gives a distinctive facial expression when the child smiles, found nocturnal lagophthalmos in 12 of them. The authors conclude that the sign needs attention to prevent damage to the eye. That is a reminder that sleeping with partly open eyes can sit alongside other signs, not a sign that your baby has such a condition.

The practical point is simple. If the eyes are the only thing, and they look well, this is usually a small matter for a routine check. If there are other things, such as unusual facial movement, bladder problems, or a lid that looks different, mention all of them together.

What does the eye doctor check, and what should I do at home?

The doctor asks about the sleep and the eyes on waking, watches the lids close when your baby is awake, looks at how the face moves, and examines the front of the eye with a light and a magnifier. The Ocular Surface review says the diagnosis rests mainly on the history and a slit lamp examination, which is a microscope with a light. If the surface of the eye has been affected, a lubricating drop or ointment is the usual start, as the urofacial syndrome study describes, and the NHS describes the same for a Bell's palsy eye.

At home, there is not much to add. Bring a short video of her asleep if you can take one without waking her, and note what her eyes look like when she wakes. Do not put drops, ointments, oils or herbal preparations on the eyes yourself, and never tape the lids shut. The NHS does mention tape to keep an eye closed at night for adults with a weak face, but that is advice given to a person by a doctor after an examination, and a baby is different. Care for the eyes, if any is needed, is whatever the doctor advises after looking.

Most of the time the plan will be a short look, a reassuring finding, and a time to return if anything changes. If it turns out the eye surface needs protection, it is much better to find out from a doctor than from a red eye.

Common questions

References

1. Latkany et al. · Nocturnal lagophthalmos: an overview and classification, Ocul Surf 2006 · pubmed.ncbi.nlm.nih.gov
2. HealthyChildren.org (American Academy of Pediatrics) · Stages of newborn sleep · www.healthychildren.org
3. All About Vision · Sleeping with eyes open (nocturnal lagophthalmos) · www.allaboutvision.com
4. Mermerkaya et al. · Nocturnal lagophthalmos in children with urofacial syndrome (Ochoa): a novel sign, Eur J Pediatr 2014 · pubmed.ncbi.nlm.nih.gov
5. NHS · Conjunctivitis · www.nhs.uk
6. NHS · Bell's palsy · www.nhs.uk

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.