Exposure keratopathy

Last updated
Exposure keratopathy
Other namesExposure keratitis
Specialty Ophthalmology
Symptoms Dryness, irritation, redness, eye pain and photophobia.
Complications Corneal opacity
CausesLagophthalmos, CN VII paralysis
Diagnostic method Eye examination
PreventionPrevention of increased corneal exposure

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.

Contents

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 tear from corneal surface. Increased evaporation of tear cause 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 protective mechanism. [1] [2] The dryness and epithelial damage will allow micro organism to penetrate cornea and thus keratitis occurs.

Signs and symptoms

Symptoms are similar to dry eye. [3] 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. [3] Corneal ulceration may develop due to bacterial invasion.

Complications

Main complication of exposure keratopathy is permanent vision loss due to corneal opacification. Stromal melting may occasionally lead to corneal perforation. [3]

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. [3]

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. [4]

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, [5] Orbital cellulitis, Orbital pseudotumor etc. [6]

Surgical

A weak bell phenomenon may result in exposure keratopathy after ptosis surgery. [3] Postoperative lagophthalmos following blepharoplasty is another common cause of secondary exposure keratopathy. [7]

Diagnosis

Fluorescein staining may be used to detect for epithelial defects, corneal infection or perforation of the cornea. [8] 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. [3] 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. [7] Bandage silicone hydrogel or scleral contact lens may be used to protect cornea. [3] But, risk of infection is more with bandage contact lens use. [7] Moisture goggles may also be used to protect cornea. [9] Temporary or permanent tarsorrhaphy may be indicated to treat lagophthalmos. Gold weights can be inserted into the upper eyelid to treat fasial nerve palsy. [9]

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. [3] Eye lid taping during sleep may alleviate mild cases of exposure keratopathy. [3]

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

Reference

  1. Zasloff, Michael (1 October 2012). "Defending the cornea with antibacterial fragments of keratin". The Journal of Clinical Investigation. 122 (10): 3471–3473. doi:10.1172/JCI65380. ISSN   0021-9738. PMC   3461931 . PMID   23006322.
  2. McDermott, Alison M. (December 2013). "Antimicrobial Compounds in Tears". Experimental Eye Research. 117: 53–61. doi:10.1016/j.exer.2013.07.014. ISSN   0014-4835. PMC   3844110 . PMID   23880529.
  3. 1 2 3 4 5 6 7 8 9 John F., Salmon (2020). "Cornea". Kanski's clinical ophthalmology : a systematic approach (9th ed.). Edinburgh: Elsevier. p. 242. ISBN   978-0-7020-7713-5. OCLC   1131846767.
  4. Tsai, Shawn H.; Yeh, Shu-I; Chen, Lee-Jen; Wu, Chien-Hsiu; Liao, Shu-Lang (1 June 2009). "Nocturnal Lagophthalmos". International Journal of Gerontology. 3 (2): 89–95. doi: 10.1016/S1873-9598(09)70027-4 . ISSN   1873-9598.
  5. Bahn, Rebecca S. (2010). "Graves' Ophthalmopathy". New England Journal of Medicine. 362 (8): 726–38. doi:10.1056/NEJMra0905750. PMC   3902010 . PMID   20181974.
  6. Goldman, Lee (2012). Goldman's Cecil Medicine (24th ed.). Philadelphia: Elsevier Saunders. pp.  2430. ISBN   978-1437727883.
  7. 1 2 3 "Exposure Keratopathy - EyeWiki". eyewiki.aao.org.
  8. Mathenge, Wanjiku (2018). "Emergency management: exposure keratopathy". Community Eye Health. 31 (103): 69. ISSN   0953-6833. PMC   6253321 . PMID   30487689.
  9. 1 2 "Lagophthalmos Evaluation and Treatment". American Academy of Ophthalmology. 1 April 2008.

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Keratitis is a condition in which the eye's cornea, the clear dome on the front surface of the eye, becomes inflamed. The condition is often marked by moderate to intense pain and usually involves any of the following symptoms: pain, impaired eyesight, photophobia, red eye and a 'gritty' sensation.

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Exophthalmos Bulging of the eye anteriorly out of the orbit

Exophthalmos is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral or unilateral. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.

Recurrent corneal erosion Medical condition

Recurrent corneal erosion is a disorder of the eyes characterized by the failure of the cornea's outermost layer of epithelial cells to attach to the underlying basement membrane. The condition is excruciatingly painful because the loss of these cells results in the exposure of sensitive corneal nerves. This condition can often leave patients with temporary blindness due to extreme light sensitivity (photophobia).

Corneal abrasion Scratch to the surface of the cornea of the eye

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Corneal ulcers in animals

A corneal ulcer, or ulcerative keratitis, is an inflammatory condition of the cornea involving loss of its outer layer. It is very common in dogs and is sometimes seen in cats. In veterinary medicine, the term corneal ulcer is a generic name for any condition involving the loss of the outer layer of the cornea, and as such is used to describe conditions with both inflammatory and traumatic causes.

<i>Acanthamoeba</i> keratitis Eye infection caused by a protist

Acanthamoeba keratitis (AK) is a rare disease in which amoebae of the genus Acanthamoeba invade the clear portion of the front (cornea) of the eye. It affects roughly 100 people in the United States each year. Acanthamoeba are protozoa found nearly ubiquitously in soil and water and can cause infections of the skin, eyes, and central nervous system.

Fungal keratitis is a fungal infection of the cornea, which can lead to blindness. It generally presents with a red, painful eye and blurred vision. There is also increased sensitivity to light, and excessive tears or discharge.

Lagophthalmos Medical condition

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Punctate epithelial erosions Medical condition

Punctate epithelial erosions are a pathology affecting the cornea.

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Graves’ ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos). It occurs most commonly in individuals with Graves' disease, and less commonly in individuals with Hashimoto's thyroiditis, or in those who are euthyroid.

Corneal ulcer Medical condition

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Herpes simplex keratitis Medical condition

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