Exposure Keratopathy

Introduction

Exposure keratopathy is the drying of the cornea as a result of inability to close the eyelids or blink adequately.

If not detected and treated, this condition can result in corneal ulceration and perforation leading to blindness.

Causes of exposure keratopathy

The following are the causes of EK:

1. Facial nerve palsy e.g. Bell’s palsy or leprosy
2. Scarring of the eyelids
3. Coma
4. Thyroid eye disease
5. Parkinson’s disease
6. Proptosis
7. Steven Johnson’s Syndrome

Symptoms of exposure keratopathy

The symptoms of EK are:

1. Feeling of drying of the eye
2. Foreign body sensations in the eye
3. Photophobia
4. Blurring of vision

Signs

1. Lagophthalmos (inability to close the eyes)
2. Incomplete blink (the upper eyelid does not cover the whole cornea during blink)
3. Infrequent blink
4. Superficial punctate stains on the cornea
5. Large coalescent corneal epithelial defect
6. Corneal ulceration
7. Corneal perforation

Investigations

• Nil

Treatment for exposure keratopathy

Objectives

1. To moisten the cornea artificially
2. To prevent the complications of dry eyes

Non-pharmacological treatment

1. Taping the eyelids closed in the comatose patient
2. Partial tarsorrhaphy
3. Education of patients with Parkinson’s or thyroid eye disease to blink frequently voluntarily rather than rely on reflex blink

Pharmacological treatment

1st Line Treatment

Evidence Rating: [C]

Hydroxymethyl cellulose, 0.3% eye drops,

• 1-2 hourly during waking time

2nd Line Treatment

Evidence Rating: [C]

Polyvinyl alcohol, 1.4-2% eye drops, 1-2 hourly during waking time

And

Chloramphenicol, 1% eye ointment, at night before bedtime

Or

Tetracycline, 1% eye ointment, at bedtime

Referral Criteria

Refer patients whose exposure keratopathy is not improving to the eye specialist.