Exposure Keratopathy

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  • Lagophthalmos = incomplete closure of the eyelids, caused by
    • Bell’s palsy
    • Eyelid deformity (scarring, ectropion, coloboma) or after eyelid surgery
    • Pronounced proptosis (e.g. Thyroid Eye Disease)
    • Medication (sedation)
    • (Physiological) nocturnal lagophthalmos
    • Neurological or neurotrophic disease (no lagophthalmos, but reduced blink reflex)


  • Lagophthalmos (measure with relaxed eyelids)
  • Bell’s phenomenon present?
  • Corneal findings: punctate keratitis, erosion, ulcer, infiltrate?


  • Lubricating therapy
    • Lacrycon gtt/ Lacrinorm gel/ Vitamin A ointment several times a day to hourly (depending on corneal findings).
    • Certainly ointment at night (Vitamin A, Bepanthen Eye and Nose ointment)
    • Watch glass bandage 24 hours or only at night (depending on corneal findings), alternatively: taping/ointment bandage
    • Consider bandage contact lenses (Cave: infection)
    • Botox ptosis
    • Tarsorrhaphy (temporary or permanent)
    • Implantation of a gold or platinum weight (into the upper eyelid)
    • Eyelid correction in case of underlying eyelid pathology


  • EyeWiki Exposure Keratopathy
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)