Exposure Keratitis

Exposure Keratitis 

  • May result from any disease process that causes inadequate eyelid closure.
  • Causes include:
    • Neurogenic diseases such as Bell's palsy, acoustic neuroma.
    • Proptosis due to thyroid orbitopathy or other orbital diseases.
    • Eyelid dysfunction from restrictive eyelid diseases or previous blepharoplasty.
    • Inattentive mental states such as in comatose patients or nocturnal exposure

Clinical features:

  • Symptoms:
    • Foreign body sensation, itching, burning and conjunctival injection
    • Decreased vision
    • Pain and photophobia may occur
  • Signs:
    • Superficial punctate epithelial staining involves inferior third of the cornea
    • May progress to large area of epithelial defect and complicated with corneal infiltrates, ulceration, perforation or endophthalmitis

Management:

  • Most important is treatment of underlying cause(s).
  • Nonpreserved topical drops during the day and lubricating ointment at bedtime.
  • Antibiotic for epithelial corneal defects.
  • Lid taping.
  • Moisture chamber glasses.
  • Temporary tarsorraphy.
  • Definitive surgical therapy.