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