ophthalmology

1. EXPOSURE
KERATOPATHY
BY
ALBERT CHELANGA
OCO/CS
6th july, 2015.

3. EXPOSURE KERATOPATHY
 In exposure keratopathy, there is failure of
the lids’ normal wetting mechanism, due to
disease process that limit eyelids closure.
 Leads to consequent drying and damage to
the corneal epithelium.

4. Causes of exposure keratopathy
VII cranial nerve palsy –
 Idiopathic (Bell’s palsy)
 Stroke
 Tumor (e.g., acoustic neuroma, meningioma,
 choleastoma, parotid, nasopharyngeal)
 Demyelination
 Sarcoidosis
 Trauma (temporal bone fracture)
 Surgical section
 Otitis
 Ramsay Hunt syndrome (Herpes zoster)
 Guillan–Barre syndrome
 Lyme disease

5.  Lid abnormality
 Nocturnal lagophthalmos
 Ectropion
 Traumatic defect in lid margin
 Surgical (e.g., overcorrection of ptosis)
 Floppy eyelid syndrome.
 Orbital disease
 Proptosis
 Thyroid eye disease

6. CLINICAL FEATURES
 Irritable, red eye(s); may be worse in the mornings.
 Foreign body sensations.
 Photophobia.
 Tearing.
 Punctate epithelial erosions;
 usually inferior if underlying lagophthalmos.
 central if due to proptosis.
 Larger defects- opportunistic microbial keratitis;-
perforation.
 Corneal anaesthesia if there is neurotrophic component.

7. PHYSICAL EXAM
• External examination may demonstrate:
- Failure of lids to close fully on blink or
voluntary
closure (lagophthalmos).
- Decreased frequency of blink.
-Widened palpebral fissure.
- Ectropion or lid position abnormalities.
- Brow ptosis (in cases of facial nerve
paralysis).

8. Treatment
 Adequate lubrication: consider high frequency or high
viscosity- preservative-free preparations -preferred if >6x/day.
 Ensure adequate lid closure:
- Use temporary measures- taping of the lids at night.
- Intermediate –
- Temporary lateral/central tarsorrhaphy.
- Botulinum toxin–induced ptosis.
- Permanent surgical procedures e.g.
- Permanent tarsorrhaphy for lagophthalmos;
- Orbital decompression if proptosis).
• Treat secondary microbial keratitis

9. Treatment Ct…
 If there is significant ulcerative thinning,
consider admission,
 Globe protection e.g.
 Glasses by day, shield at night.
 Taping.
 Bandage contact lens, or
 Lamellar grafting.

10. PREVENTION
• Assess corneal protective mechanisms:
check corneal sensation, tear film, lid closure
(CN VII), Bell’s phenomenon; correct where
possible.
• Warn patient of risk of corneal disease and
that pain, photophobia, or reduced V/A
requires urgent ophthalmic assessment.

11. DIFFERENTIAL DIAGNOSIS
• Dry eye syndrome.
• Sjogren's syndrome.
• Neurotrophic keratopathy.
• Medicamentosa.
• Blepharitis.

12. REFERENCES
 Oxford American Handbook of
ophthalmology
 A Textbook Of Clinical Ophthalmology - 3rd
Edition
 Fundamentals and Principles of
Ophthalmology- section 2. -(2011-2012)