exposure keratopathy

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    Exposure keratopathy (also known as exposure keratitis) is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity.
    Normally, corneal surface is kept moist by blinking. During sleep, it is covered by lids. Increased corneal exposure to the air due to incomplete or inadequate eyelid closure cause increased evaporation of tears from corneal surface. Increased evaporation of tears causes instability of the tear film and dryness of corneal surface. This will lead to corneal epithelial damage. Both tear film and corneal epithelium play significant role in corneal protection. The dryness and epithelial damage allows micro-organisms to penetrate the cornea and thus keratitis occurs.


    Signs and symptoms


    Symptoms are similar to dry eye. Patients may complain redness, irritation, ocular discomfort, burning, and foreign body sensation. Punctate epithelial defects, epithelial break down and stromal melting may be seen in corneal examination. Corneal ulceration may develop due to bacterial invasion.


    = Complications

    =
    The main complication of exposure keratopathy is permanent vision loss due to corneal opacification. Stromal melting may occasionally lead to corneal perforation.


    Causes


    Exposure keratopathy may occur due to mechanical eyelid abnormalities or neuro-paralytic corneal anesthesia. It may occur secondary to ocular surgeries like blepharoplasty, ptosis surgery etc. also.


    = Lagophthalmos

    =

    Lagophthalmos, the inability to close the eyelids completely is the main cause of exposure keratopathy. Common cause of lagophthalmos is facial nerve (CN VII) palsy. Facial nerve function may affect in several conditions like cerebrovascular accident, head trauma, brain tumors, Bell's palsy etc. Physiological inability to close the eyelids during sleep (nocturnal lagophthalmos) may also cause exposure keratopathy.


    = Mechanical causes

    =
    Chemical or thermal burns to eyelids or conjunctiva, ocular cicatricial pemphigoid, or symblepharon may cause incomplete or inadequate eyelid closure.


    = Exophthalmos

    =

    Exophthalmos is the unilateral or bilateral bulging of the eye anteriorly out of the orbit causing increased exposure of cornea. It may be seen in many conditions like Graves' ophthalmopathy, Orbital cellulitis, Orbital pseudotumor etc.


    = Surgical

    =
    A weak bell phenomenon may result in exposure keratopathy after ptosis surgery. Postoperative lagophthalmos following blepharoplasty is another common cause of secondary exposure keratopathy.


    Diagnosis


    Fluorescein staining may be used to detect for epithelial defects, corneal infection or perforation of the cornea. Tear break-up time and ocular protection index assessment can be done to reveal dry eye. Exophthalmometry can be used to measure degree of exophthalmos.


    Prevention


    If increased corneal exposure is detected, several preventive measures can be done to prevent keratitis. Aritificial eye drops and eye ointments may be used to keep the eyes moist. Since frequent use of eye drops with preservatives can promote inflammation, it is better to choose preservative free artificial tear drops and lubricating eye drops. Bandage silicone hydrogel or scleral contact lens may be used to protect cornea. But, risk of infection is more with bandage contact lens use. Moisture goggles may also be used to protect cornea. Temporary or permanent tarsorrhaphy may be indicated to treat lagophthalmos. Gold weights can be inserted into the upper eyelid to treat fasial nerve palsy.


    Treatment


    Treatment of the cause of the exposure is to be done first. For example, in proptosis due to thyroid eye disease, regulation of thyroid hormone levels may be advised. Symblepharon can be treated surgically. If necessary, management of proptosis may be done by orbital decompression. Eyelid taping during sleep may alleviate mild cases of exposure keratopathy.
    If corneal ulcer is detected, it may be treated medically with antibiotics. If corneal perforation has occurred, immediate treatment measures should be done to restore the integrity of perforated cornea. Tissue adhesive glues, covering with conjunctival flap, bandage soft contact lens or therapeutic keratoplasty may be indicated to treat perforated corneal ulcer.


    See also


    Keratitis
    Dry eye syndrome
    Lagophthalmos


    References

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exposure keratopathy

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Management of Exposure Keratopathy

Apr 1, 2014 · Decreased lubrication of the ocular surface due to inadequate eyelid closure or decreased blink frequency can lead to exposure keratopathy. This review will discuss the diagnosis and treatment of this form of dry eye syndrome. Symptoms and signs.

Exposure Keratopathy - EyeWiki

Exposure keratopathy (EK) is damage to the cornea that occurs primarily from prolonged exposure of the ocular surface to the outside environment. EK can lead to ulceration, microbial keratitis, and permanent vision loss from scarring.

Exposure keratopathy - Wikipedia

Exposure keratopathy (also known as exposure keratitis) is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity. Normally, corneal surface is kept moist by blinking. During sleep, it is covered by lids.

Keratopathy - StatPearls - NCBI Bookshelf

Aug 25, 2023 · Exposure keratopathy: Exposure keratopathy is a consequence of the inability to maintain uniform tear film distribution over the ocular surface. Tear film helps in maintaining the epithelial integrity and thus prevents any epithelial denudation.

Management of Exposure Keratopathy - American Academy …

can lead to exposure kera-topathy. This review will discuss the diagnosis and treatment of this form of dry eye syndrome. Overview Symptoms and signs. Common symp-toms of exposure keratopathy include pain, foreign body sensation, epiphora, photophobia, and blurry vision. Pa-tients with decreased corneal sensation may experience minimal nociceptive

Symptoms, Causes, and Treatments of Exposure Keratitis - WebMD

Jul 10, 2023 · If your eye won't shut all the way, you could get exposure keratitis. This condition causes painful eyes and blurry vision. WebMD tells you what causes it and what to do about it.

What Is Keratopathy of the Eyes? - All About Vision

Jun 8, 2022 · 9. Exposure keratopathy. Incomplete closure of the eyelids, insufficient blink rate or reflex, and an unstable tear film can disrupt the corneal surface. This results in exposure keratopathy. Typically, the corneal surface is protected by the eyelids and tear film. When this protection is compromised, the cornea can become damaged. Signs and ...

Exposure Keratopathy in the Critically Ill: - University of Iowa

Jul 1, 2014 · Exposure keratopathy is dryness of the cornea caused by incomplete or inadequate eyelid closure, resulting in evaporative tear loss and tear film insufficiency. Mild cases are usually benign and easily treated, but if severe, undiagnosed, and/or under …

Exposure keratopathy: Incidence, risk factors and impact of

Purpose: We aimed to determine the rate of exposure keratopathy (EK) in critically ill patients, identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK.

Exposure Keratopathy Practice Management Guideline

Exposure keratopathy is caused by decreased lubrication of the ocular surface due to inadequate eyelid closure or decreased blink frequency. ICU patients are at high risk for this due to impairment of the above protective eye mechanisms which make this population susceptible to corneal dehydration, abrasions, perforation, and infection.