There appeared to be no obvious relationship between eyelid non-closure and the presence of cyanosis, medications (particularly sedatives), religious affiliation, terminal restlessness, or overt family turmoil. In 30% of the eye open group, excluding those with primary cerebral tumours, there were known cerebral metastases, whereas cerebral metastases were recognised in only 16% of those who died with their eyes closed. Clinically recognisable gross hepatic dysfunction was noted in 40% of those who died with eyes open, compared to 29% of the eye-closed group. Over 80% of the small number of those who died with a cerebral tumour and 36-42% of gastrointestinal, breast and lung cancer deaths did not have eyelid closure. myasthenia gravis), oculomotor nerve palsies, age related levator dehiscence, orbitofacial trauma, eye infection, blepharospasm, conversion hysteria and cortical вЂptosisвЂ™.ДЄ concerned and distressed Asian relative of a jaundiced patient dying of a gastrointestinal malignancy prompted the author to clinically investigate eyelid position near to and at death. The differential diagnoses of ptosis includes congenital deformity, myopathy (e.g. вЂLid watching,вЂ™ however, is a lost medical art. Thus in life, ptosis was considered to be a very poor prognostic sign. For, if some part of the white appears when the lids are closed and it is not due to diarrhea, drug-taking nor is it the normal habit in sleep, it is a bad sign and especially fatalвЂ™. He wrote, in respect to prognosis, that вЂthe appearance of the eyes in sleep should be considered. Hippocrates (460-370 BC) commented upon the position of the eyelids in sleep in mortally ill persons. Shaw remarked upon this clinical sign in several of her Singaporean case vignettes. There is virtually no modern literature on the prevalence of eye closure at death, or the causes of open eyelids post-mortem. In such societies the startled post-mortem appearance of fixed open eyes suggests a fearful, and not a peaceful judgement. A concentration camp survivor describing the awful, delirious death of a school friend during internment wrote вЂwhen I looked at him again he was deadвЂ¦ his eyes, wide open with alarm, stared into nothingnessвЂ™ Chinese (and Taoist) belief suggests that the dead have to be judged in hell and punished according to the sins that they have committed in life. Such an interpretation is invited in the newspaper headline вЂBomber McVeigh dies, eyes wide open,вЂ™ referring to the execution of the Oklahoma City bomber. Open eyes at death may be interpreted as an indication that the deceased is fearful of the future, presumably because of past behaviors. The practice of forcing eyelids closed immediately after death, sometimes using coins to lock the eyelids closed until rigor mortis intervenes, has been common in many cultures. Surviving relatives and attending staff may associate closed eyes at death with peacefulness and restfulness, and opened eyes with discomfort or even fear.

Youtype eyes wide open