In nursing homes or during home visits, we regularly observe elderly individuals who keep their eyelids closed, even during conversations. Those around them perceive this as fatigue, sometimes as disinterest. In the majority of cases, this reflex indicates a protective mechanism in response to issues that aging imposes on the eye, the brain, or balance.
Apraxia of Eyelid Opening: An Underdiagnosed Neurological Disorder
When an elderly person cannot reopen their eyes after blinking, we spontaneously think of drowsiness. In practice, especially in nursing homes, this blockage occurs too frequently to be reduced to mere fatigue.
Related reading : What to do if your Vinted package is not picked up by the seller? Deadlines and solutions
Apraxia of eyelid opening is a distinct diagnosis: the person has difficulty initiating the opening of the eyelids, even in the absence of visible spasms. It is neither a refusal to look nor a classic blepharospasm. The mechanism is neurological, related to a dysfunction of the motor circuits that control the eyelid elevator.
The confusion with fatigue or disengagement often delays management. A referral to an ophthalmologist or neurologist allows for diagnosis and, in some cases, the proposal of botulinum toxin injections or targeted rehabilitation. This topic is documented in health articles on Just Healthy, which detail the medical causes of this behavior.
Related reading : Why Voice Search Stops and How to Easily Reactivate It?
Late Blepharospasm and Medications: A Cause That No One Investigates
In geriatrics, the list of daily medications often exceeds ten different molecules. Among the rarely monitored side effects, late drug-induced blepharospasm remains a neglected angle.
Some treatments, particularly long-term neuroleptics and antiemetics, can cause involuntary and repeated contractions of the orbicularis muscles. The eyelid closes uncontrollably, sometimes several times per minute. The phenomenon, described as “late blepharospasm” in the neurological literature, constitutes a clinical entity distinct from so-called essential blepharospasm.
What We Observe in Care Facilities
The resident closes their eyes in a jerky manner, especially at the end of the day or in a bright environment. The caregiving team sometimes notes an exacerbation after a change in treatment. When the causative molecule is reduced or adjusted, the spasms decrease within a few weeks.
The trap: attributing these closures to dementia or apathy without reviewing the prescription. A targeted medication review with the coordinating physician or the nursing home pharmacist is one of the first reflexes to have.
Ocular Dryness and Incomplete Nighttime Closure in Seniors
We underestimate how much ocular dryness weighs on the daily lives of elderly individuals. Tear production decreases with age, the conjunctiva thins, and the surface of the eye becomes vulnerable to every draft or bright light.
The TFOS DEWS III report of 2025 highlights a mechanism often ignored: incomplete eyelid closure during sleep worsens ocular dryness at night. The cornea remains partially exposed, dry, and upon waking, discomfort causes the person to keep their eyes closed longer during the day.
Signs to Spot Daily
- Persistent redness upon waking, with a sandy sensation described by the resident or patient
- Frequent and prolonged blinking upon exposure to direct natural or artificial light
- Tendency to keep eyelids half-closed during meals or group activities, even without apparent drowsiness
An ophthalmological assessment allows for measuring the quality of the tear film. Artificial tears, applied several times a day, relieve a good portion of cases. For residents who do not completely close their eyelids at night, protective ocular devices exist, although feedback on this point varies according to individual tolerance.
Degraded Vision and Fall Risk: Why Keeping Eyes Closed Protects Balance
This point often surprises families. Keeping the eyes closed is not always a sign of withdrawal. It is sometimes an unconscious strategy to stabilize a precarious balance.
When the lens becomes cloudy (cataract) or the retina deteriorates (AMD), the visual information sent to the brain becomes contradictory. The ground seems to move, distances are misjudged, and the risk of dizziness increases. By closing their eyes, the elderly person eliminates these distracting visual signals and refocuses on proprioceptive (muscles, joints) and vestibular (inner ear) information.
An Indicator of Fragility to Take Seriously
Healthcare professionals consider this habit as a marker of fall risk. In practice, when it is noticed that a resident consistently keeps their eyes closed while sitting or during transfers, three things need to be checked:
- The date of the last ophthalmological assessment and the state of the visual correction being worn
- The presence of positional vertigo or associated vestibular disorders
- The adaptation of lighting in the room and living spaces (light too harsh or, conversely, insufficient)
- Current treatments that may impair vision or balance (psychotropics, antihypertensives)
Adjusting the lighting, scheduling a consultation with an ophthalmologist, and reviewing the prescription are the three immediate levers. Cataract surgery, when possible, significantly reduces the risk of falls and often restores spontaneous eye opening.
Keeping the eyes closed is never trivial in an elderly person. Behind this seemingly banal gesture, there are often neurological, medication-related, ocular, or postural causes that accumulate. The first step remains to discuss it with the treating physician, without reducing this behavior to a mere desire to sleep.