Exposure keratitis . It is the result of incomplete eyelid closure or lagophthalmos , which causes corneal dryness.
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- 1 Causes
- 2 Symptoms
- 3 Critical signs
- 4 Other signs
- 5 Diagnostic protocol
- 6 Treatment protocol
- 1 Medical treatment
- 2 Surgical treatment
- 7 Follow-up
- 8 Source
- Neuroparalitic: mainly due to paralysis of the facial nerve, which can be idiopathic or secondary to surgery for an acoustic neuroma or a parotid tumor .
- Eyelid deformities ( scars , ectropion , scar fibrosis due to trauma or caustication).
- Previous eyelid surgery ( ptosis , blepharoplasty ).
- Severe proptosis ( thyroid ophthalmopathy , orbital mass).
- Night lagophthalmia: inability to close the eyelids during sleep.
- In coma or Parkinson’s , where muscle tone is reduced.
- Red eye.
- Foreign body sensation.
- Blinking or incomplete closing of the eyelids , causing corneal dryness.
- Superficial dotted keratitis in the lower third of the cornea or as a horizontal band in the eyelid fissure that stains with fluorescein.
- Cilioconjunctival injection.
- Corneal edema .
- Corneal erosion .
- Infiltrated epithelial defect, which can become stromal and even lead to perforation.
- Eyelid deformity or incomplete eyelid closure.
- History : History of previous eyelid surgery or thyroid disease.
- Assess eyelid closure, degree of corneal exposure. Ask the patient to close both eyes without forcing. Evaluate the Bell phenomenon . Evaluate eyelid laxity.
- Slit lamp biomicroscopy of the anterior segment: superficial corneal stippling in the area of the palpebral fissure or the lower third, which is stained with fluorescein. Look for signs of secondary infection: corneal infiltrate, anterior chamber reaction, intense conjunctival injection.
- Investigate any underlying disorders (eg cause of VII cranial nerve palsy).
The most important thing is to correct the causal factor.
- Artificial tears eyedrops every 2 h.
- Gel tears when sleeping or 4 times a day.
- In some cases it is convenient to occlude the eyelids at night with adhesive strips.
- Therapeutic soft contact lenses.
When the maximum medication is inoperative, to avoid corneal deterioration, one of the following surgical procedures can be performed:
- Correction of eyelid deformity (eg ectropion ).
- Temporary tarsorrhaphy or permanent tarsorrhaphy .
- Conjunctival or amniotic membrane coating.
- In case of proptosis : decompression of orbit if indicated.
- In less severe cases, from weeks to months.