Exposure keratitis

Exposure keratitis . It is the result of incomplete eyelid closure or lagophthalmos , which causes corneal dryness.

Summary

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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

Causes

• 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.

Symptoms

• Red eye.
• Foreign body sensation.

Critical signs

• 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.

Other signs

• Cilioconjunctival injection.
• Corneal edema .
• Corneal erosion .
• Infiltrated epithelial defect, which can become stromal and even lead to perforation.
• Eyelid deformity or incomplete eyelid closure.

Diagnostic protocol

• 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).

Treatment protocol

The most important thing is to correct the causal factor.

Medical treatment

1. Artificial tears eyedrops every 2 h.
2. Gel tears when sleeping or 4 times a day.
3. In some cases it is convenient to occlude the eyelids at night with adhesive strips.
4. Therapeutic soft contact lenses.

Surgical treatment

When the maximum medication is inoperative, to avoid corneal deterioration, one of the following surgical procedures can be performed:

1. Correction of eyelid deformity (eg ectropion ).
2. Temporary tarsorrhaphy or permanent tarsorrhaphy .
3. Conjunctival or amniotic membrane coating.
4. In case of proptosis : decompression of orbit if indicated.

Tracing

• In less severe cases, from weeks to months.