Keratopathy exposure

Exposure keratopathy Elevated intraocular pressure Contralateral amaurosis Respiratory arrest Bradycardia... 

Numerous neurologic and mechanical fectors may result in chronic corneal drying due to infrequent or incomplete blinking or inadequate eyelid closure (lagophthalmos). The resultant irritation to the corneal tissue is known as exposure keratopathy. 

Patients with exposure keratopathy may develop filamentary keratitis.The dry eye can cause corneal irregularities and increased mucin, which promotes the formation of fine epithelial and mucous strands that are attached to... 

Figure 26-32 Patient with exposure keratopathy exhibits staining interiorly/intrapalpebrally with rose bengal. (Courtesy of Pat Caroline.)...

If exposure keratopathy is the result of an ocular or systemic abnormaUty, the underlying condition should be addressed. Patients with exposure keratopathy resulting from Bell s palsy or Graves disease often are comanaged by a physician caring for the systemic problem together with the eye care practitioner attending to the ocular complications. 

Staphylococcal blepharitis Ectropion Entropion Lagophthalmos Exposure keratopathy Interpalpebral... 

Figure 32-7 Severe exposure keratopathy of the left eye of a patient with class 5 Graves ophthalmopathy.

Proptosis, as an isolated finding, rarely requires treatment unless there is secondary exposure keratopathy or unless it represents a significant cosmetic problem. Affected patients may benefit from a trial of systemic corticosteroids. A significant decrease in the severity of proptosis may be observed in some patients. In general, if regression of the proptosis occurs after the institution of steroid therapy, it will begin soon after the onset of therapy and reach a maximum in 2 or 3 months. If no response to steroid therapy is seen after 3 to 4 weeks, the therapy should be discontinued. As mentioned previously, response to corticosteroid therapy for proptosis is variable at best. 

Graves ophthalmopathy severe enough to warrant high-dose steroids, orbital radiotherapy, or orbital decompression is estimated to occur in not more than 20% of patients with Graves disease. In most cases the disorder can be managed adequately with more conservative therapeutic measures. In most patients minor interventions that are required mainly include treatment of exposure keratopathy. Table 32-4 summarizes the current therapeutic approaches to the patient with Graves ophthalmopathy. 

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