Exposure Keratopathy

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Exposure keratopathy is the drying of the cornea as a result of inability to close the eyelids or blink adequately. If not detected and treated can result in corneal ulceration and perforation leading to blindness.

Cause

  • Facial nerve palsy e.g. Bell’s palsy or leprosy
  • Scarring of the eyelids
  • Coma
  • Thyroid eye disease
  • Parkinson’s disease
  • Proptosis
  • Steven Johnson’s Syndrome

Symptoms

  • Feeling of drying of the eye
  • Foreign body sensations in the eye
  • Photophobia
  • Blurring of vision

Signs

  • Lagophthalmos (inability to close the eyes)
  • Incomplete blink (the upper eyelid does not cover the whole cornea during blink)
  • Infrequent blink 
  • Superficial punctate stains on the cornea 
  • Large coalescent corneal epithelial defect
  • Corneal ulceration 
  • Corneal perforation

TreatmentTreatment Objectives

  • To moisten the cornea artificially
  • To prevent the complications of dry eyes 

Non-pharmacological treatment

  • Taping the eyelids closed in the comatose patient 
  • Partial tarsorrhaphy 
  • Education of patients with Parkinson’s or thyroid eye disease to to blink frequently voluntarily rather than rely on reflex blink

Pharmacological treatment 

1st Line Treatment

Evidence Rating: [C]

  • Hydroxymethyl cellulose, 0.3% eye drops, 1-2 hourly during waking time

2nd Line Treatment

Evidence Rating: [C]

  • Polyvinyl alcohol, 1.4-2% eye drops, 1-2 hourly during waking time 

And  

  • Chloramphenicol, 1% eye ointment, at night before bedtime

Or

  • Tetracycline, 1% eye ointment, at bedtime

Referral Criteria

  • Refer patients whose exposure keratopathy is not improving to the eye specialist.