Cornea
Exposure Keratopathy
Also known as: lagophthalmos keratopathy, exposure keratitis, waking pain cornea
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Overview
Corneal surface disease caused by inadequate lid closure or tear film protection, often worse on waking.
Recognition
Symptoms: what patients report
- Foreign body sensation and grittiness, worse on waking.
- Burning or dryness that worsens through the day in wind or air-conditioning.
- Redness of the lower part of the eye.
- Blurred vision that clears with blinking or a drop.
Signs: what the examination shows
- Inferior interpalpebral punctate epithelial staining — the exposed band between the lids.
- Incomplete lid closure on gentle closure or blink; lagophthalmos measurable in millimetres.
- Poor or absent Bell's phenomenon (the eye does not roll up on forced closure), which removes the protection the cornea would otherwise have.
- Lid retraction, proptosis, or facial nerve weakness explaining the exposure.
- Epithelial defect, filaments or, in advanced cases, stromal haze, infiltrate or thinning.
- Conjunctival injection in the exposed zone.
What OptoGuide™ covers for exposure keratopathy
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Ocular surface disorders in intensive care patients — systematic review
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Understanding the Pathogenesis of Neurotrophic Keratitis: The Role of Corneal Nerves. Mastropasqua L, Massaro-Giordano G, Nubile M, Sacchetti M. Journal of Cellular Physiology. 2017;232(4):717-724.
- Descemetocele and Bilateral, Severe Pseudomonas Keratitis in an Intensive Care Unit Patient With Graves' Orbitopathy: A Case Report. Hsieh YC, Chen CC. Medicine. 2020;99(40):e22481.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.