Summary about Disease
Exposure keratopathy refers to corneal damage (the clear front surface of the eye) that occurs due to inadequate eyelid closure or tear film coverage, leading to corneal drying and subsequent inflammation and potential damage. The cornea is normally kept moist and protected by the eyelids and tear film. When this protective mechanism is compromised, the cornea becomes vulnerable to environmental factors and can develop lesions.
Symptoms
Dry eye sensation
Foreign body sensation (feeling like something is in your eye)
Burning or stinging
Excessive tearing (paradoxical tearing, where the eye is dry but produces a lot of tears)
Redness
Blurred vision
Light sensitivity (photophobia)
Pain, especially with eye movement
In severe cases, corneal ulceration which can cause significant pain and vision loss.
Causes
Incomplete eyelid closure (lagophthalmos): This can be caused by:
Bell's palsy (facial nerve paralysis)
Stroke
Trauma to the eyelids
Ectropion (eyelid turning outward)
Proptosis (bulging of the eye)
Surgery (e.g., blepharoplasty)
Reduced blink rate: This can be due to:
Concentration (e.g., computer use)
Parkinson's disease
Certain medications (antihistamines, antidepressants)
Decreased tear production (dry eye syndrome):
Sjogren's syndrome
Aging
Medications
Eyelid abnormalities:
Ectropion
Entropion (eyelid turning inward)
Nocturnal lagophthalmos: Inability to close the eyelids completely during sleep.
Medicine Used
Artificial tears: Frequent use of lubricating eye drops to keep the cornea moist.
Ointments: Lubricating ointments for nighttime use to provide prolonged lubrication.
Topical steroids: In some cases, mild topical steroids may be used to reduce inflammation, but must be used with caution due to potential side effects.
Antibiotics: If a corneal ulcer develops, antibiotic eye drops or ointments are prescribed to prevent or treat infection.
Cyclosporine or Lifitegrast: Medications that can help increase tear production in cases associated with dry eye.
Botulinum Toxin (Botox): In some cases, Botox injections can be used to temporarily paralyze the upper eyelid muscle, allowing the eyelid to close more fully.
Is Communicable
No, exposure keratopathy is not communicable. It is a condition caused by inadequate corneal protection, not by an infectious agent.
Precautions
Regular use of artificial tears: Use lubricating eye drops frequently, especially during the day.
Use of lubricating ointment at night: Apply a thick lubricating ointment to the eyes before bedtime.
Humidifier: Use a humidifier, especially in dry environments or during the winter.
Avoid drafts: Protect your eyes from drafts of air.
Eyelid taping: In cases of nocturnal lagophthalmos, tape the eyelids closed at night.
Moisture chambers: Wear moisture chamber glasses or goggles to create a humid environment around the eyes.
Manage underlying conditions: Address any underlying conditions that may be contributing to the problem, such as dry eye syndrome or Bell's palsy.
Regular eye exams: See an eye doctor regularly for monitoring and treatment.
How long does an outbreak last?
Exposure keratopathy is not an outbreak in the sense of an infectious disease. It is a chronic condition that can persist for a long time if the underlying cause is not addressed and appropriate management is not implemented. The duration of symptoms can vary depending on the severity of the condition, the effectiveness of treatment, and the presence of any underlying medical conditions.
How is it diagnosed?
Comprehensive eye examination: An eye doctor will examine the eyes to assess the cornea, eyelids, and tear film.
Slit-lamp examination: A slit lamp is a microscope used to examine the eye in detail.
Tear film evaluation: Tests to assess tear production and tear film quality, such as Schirmer's test, tear breakup time (TBUT), and tear osmolarity testing.
Fluorescein staining: Fluorescein dye is applied to the eye, and a blue light is used to examine the cornea for any areas of damage or dryness.
Lissamine green staining: Similar to fluorescein, but stains devitalized conjunctival cells.
Evaluation of eyelid closure: Assessing the ability to close the eyelids completely.
Medical history: Review of the patient's medical history and medications to identify any potential contributing factors.
Timeline of Symptoms
The timeline of symptoms can vary significantly depending on the cause and severity:
Early Stages: Mild dryness, foreign body sensation, and intermittent blurred vision. Symptoms may be worse at the end of the day or after prolonged visual tasks.
Progressive Stages: Increased dryness, burning, stinging, redness, and light sensitivity. Symptoms become more constant.
Advanced Stages: Significant pain, constant blurred vision, corneal ulceration, and potential vision loss. The timeline from early to advanced stages can range from weeks to months or even years if left untreated.
Important Considerations
Underlying Cause: Identifying and addressing the underlying cause of the exposure is critical for effective management.
Compliance: Consistent use of prescribed medications and adherence to recommended precautions are essential.
Complications: Untreated exposure keratopathy can lead to corneal ulceration, infection, scarring, and permanent vision loss.
Individualized Treatment: Treatment plans should be tailored to the individual patient's needs and the specific cause of the condition.
Surgical Intervention: In some cases, surgical procedures such as eyelid surgery (e.g., tarsorrhaphy - partial or complete closure of the eyelids) may be necessary to protect the cornea.
Neurological Evaluation: If facial nerve paralysis is suspected, a neurological evaluation may be necessary.