Abstract: Exposure keratopathy is a sight-threatening condition characterized by corneal epithelial damage due to inadequate eyelid closure or insufficient tear film protection. This article provides a comprehensive overview of exposure keratopathy, exploring its underlying causes, clinical manifestations, diagnostic approaches, and therapeutic interventions to mitigate ocular surface damage and preserve vision.

Introduction: Exposure keratopathy poses a significant challenge in ophthalmology, particularly in patients with compromised eyelid function or reduced tear production. Understanding the mechanisms underlying exposure keratopathy is essential for timely intervention and prevention of corneal complications.

Causes and Risk Factors: Exposure keratopathy may arise from various factors leading to inadequate eyelid closure or impaired tear film distribution. Common causes include facial nerve palsy, proptosis, lagophthalmos, lid malposition, nocturnal lagophthalmos, and neurotrophic keratopathy. Patients undergoing prolonged mechanical ventilation or with reduced blink frequency are also at risk. (Source: American Academy of Ophthalmology – Exposure Keratopathy)

Clinical Presentation: Patients with exposure keratopathy may present with symptoms such as ocular discomfort, foreign body sensation, redness, tearing, and blurred vision. Clinical examination may reveal corneal epithelial defects, punctate keratopathy, filamentary keratitis, or corneal erosions. In severe cases, corneal ulceration and perforation may occur, leading to vision loss and ocular morbidity.

Diagnosis: Diagnosing exposure keratopathy involves a comprehensive ocular examination, including assessment of eyelid function, tear film dynamics, and corneal integrity. Fluorescein staining, slit-lamp biomicroscopy, and measurement of tear film breakup time aid in confirming the diagnosis and assessing disease severity. Evaluation for underlying systemic conditions contributing to ocular surface compromise is also essential.

Management Strategies: Management of exposure keratopathy aims to protect the ocular surface, promote corneal healing, and prevent further epithelial damage. Treatment options may include lubricating eye drops, ophthalmic ointments, moisture chamber goggles, and eyelid taping or surgery to optimize eyelid closure. In severe cases, amniotic membrane transplantation or surgical correction of lid abnormalities may be necessary to preserve vision and prevent complications.

Prognosis and Complications: The prognosis of exposure keratopathy depends on the underlying cause, disease severity, and promptness of intervention. With timely treatment and proper ocular surface protection, most cases of exposure keratopathy resolve without long-term sequelae. However, untreated or recurrent exposure keratopathy may lead to corneal scarring, perforation, and permanent vision loss.

Conclusion: Exposure keratopathy represents a significant ocular challenge, requiring prompt recognition and intervention to prevent corneal complications and preserve vision. By understanding its etiology, clinical features, and management strategies, ophthalmologists can effectively diagnose and treat exposure keratopathy, ultimately improving patient outcomes and quality of life.