Intraocular pressure was 15 mmHg in both eyes. The pupils were round, regular, and reactive in both eyes without relative afferent defect. Visual acuity without correction showed 0.5 loss in the right eye and 0.6 in the left, with no improvement by refraction. There was no family history of lagophthalmos or any ocular problems, and no history of trauma, surgery, redness, or discharge. She was not taking any systemic or ocular medication. She had experienced intermittent nocturnal lagophthalmos for years before the present complaint was noted. The spots had gradually increased in size, and there was an associated blurring of vision that could not be corrected via refraction. Ī 21-year-old Saudi woman presented to the Anterior Segment Clinic at King Fahad University Hospital in Al-Khobar City, complaining of whitish spots in both eyes, which had developed over the past three years. Common signs include incomplete blinking, lagophthalmos, reduced tear meniscus, reduced tear film breakup time, corneal filament formation, punctate epithelial erosion, and epithelial defects. In severe cases, the condition can lead to corneal ulcers and microbial keratitis. Ĭlinical presentations of exposure keratopathy include blurred vision, eye irritation, red eyes, and dry eyes. All of these manifestations tend to occur more commonly in the lower part of the cornea. In addition, slit lamp examination can reveal various manifestations including punctuate and macro epithelial erosion, stromal opaqueness (whitening) with epithelial defects, and stromal scars. Another potentially devastating presentation is corneal thinning, which can progress to full-thickness perforation. One is infectious keratitis, and the associated disintegration of the epithelium and loss of antimicrobial components of the tear film such as beta lysin, lactoferrin, and immunoglobulins can increase susceptibility to infection. Ī wide range of pathologies can result from prolonged exposure of the corneal surface. Exposure keratopathy reportedly develops in 3.6-60% of patients who stay in ICUs. Incomplete eyelid closure or lagophthalmos is a major risk factor for exposure keratopathy. Unclosed eyelids and incomplete blinking are the main causes of exposure keratopathy. Eyelid closure and blinking are responsible for replenishing and spreading the tear film across the corneal surface and restricting evaporation of the tear film. It may be due to inadequate eyelid closure, which results in reduced lubrication of the ocular surface by tears. This was a rare case of exposure keratopathy with bilateral lagophthalmos of idiopathic origin, and a challenging one, which prompted the researchers to formulate an appropriate treatment plan.Įxposure keratopathy is characterized by dryness of the cornea with subsequent epithelial breakdown. Based on these findings, she was diagnosed with exposure keratopathy resulting from idiopathic bilateral lagophthalmos and treated with lubricants. Laboratory results were normal there was an absence of proptosis, and no epithelial defects were apparent. Examination revealed bilateral lagophthalmos, good Bell’s phenomenon, bilateral inferior corneal scars, and vision loss. She had no remarkable history of medication use, trauma, surgery, cranial nerve abnormality, critical illness, or other ocular problems. Herein, we describe a case of exposure keratopathy with bilateral idiopathic lagophthalmos and discuss factors pertaining to prompt diagnosis and treatment.Ī 21-year-old woman presented with bilateral nocturnal lagophthalmos, blurred vision, and whitish spots in both eyes. Exposure keratopathy refers to corneal damage that results primarily from prolonged exposure of the ocular surface to the outside environment.
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