Why Do the Eyes Sometimes Stay Open After Death?

Many people are startled to find that a loved one’s eyes are open after death. Some worry it means the person was afraid, or in distress. This article explains what research shows. It is based largely on one careful study, and several hospice and health-authority guides describe the same thing.

How common is it?

More common than most people think. In 2009, a palliative care doctor in New Zealand, Dr. A. D. Macleod, recorded eyelid position in 100 consecutive deaths at a hospice. At death, 63 patients had full closure of the eyelids, and 37 had eyelids open, showing at least the lower half of the white of the eye. The author notes there was almost no modern literature on how often this happens.

Health authorities list open eyes among ordinary signs at death. Island Health in British Columbia tells caregivers that after death the eyes are not moving and may be open or closed, the mouth may fall open as the jaw relaxes, and the skin becomes pale and waxy.

What controls the eyelids?

Active muscle control. Macleod says eye closure is an active process that depends on a working central nervous system, and that total eye closure is usual in sleep, coma, and death. Complete closure comes from the orbicularis oculi muscles, controlled by the facial nerve, along with reduced activity of the levator muscle that lifts the lid, controlled by the oculomotor nerve. Levator tone diminishes with sleep and drowsiness.

Does it mean the person was afraid?

No, according to the study. Macleod writes that in some societies open eyes at death have been seen as a sign of fear or a troubled judgment, and that complete closure suggests peacefulness. But he found no apparent link between lids staying open and cyanosis, medications such as sedatives, religious affiliation, terminal restlessness, or open family conflict. He concluded that an organic cause, not a psychological one, is the likely reason the lids fail to close fully.

Who is more likely to have open eyes?

It depends on the illness. In the study, more than 80 percent of the small number of patients who died with a brain tumor, and 36 to 42 percent of those who died of gastrointestinal, breast, and lung cancers, did not have full eyelid closure.

What can families do?

Know it is physical, and that you have choices. The Canadian Cancer Society says it is okay to touch and hug a loved one after they die, and okay to gently close the eyelids if they are still open and you would feel more comfortable. A hospice instruction sheet says stiffening can begin in as little as 10 minutes or take up to six hours, so if you want to close the eyes, do it soon.

If the lids will not stay closed, ask the nurse or funeral director. Nurses at NHS Lothian in Scotland are instructed to hold the eyelids closed for about 30 seconds or place moistened gauze over them until they stay closed, and not to tape the eyes shut because it can leave marks.

For what the body goes through, see What Happens to Your Body in the First 24 Hours After Death, Rigor Mortis, Livor Mortis, and Algor Mortis, and What to Expect in the Final Hours.