Managing Exposure Keratitis: How Scleral Lenses Can Help

Exposure keratitis is a condition that results from inadequate eyelid coverage of the ocular surface, leading to corneal drying and subsequent damage. This can significantly impact a patient’s comfort, vision, and quality of life. Scleral lenses are a valuable treatment option for protecting the ocular surface and improving overall outcomes in patients with exposure keratitis.

Protecting the Ocular Surface with Scleral Lenses

The primary challenge in exposure keratitis is maintaining a healthy and hydrated ocular surface. When the eyelids fail to close fully, the cornea is exposed to the external environment, causing evaporation of the tear film and leading to epithelial breakdown. Scleral lenses provide a unique therapeutic benefit by creating a protective reservoir of fluid that continuously bathes the cornea throughout wear.

Unlike traditional contact lenses, scleral lenses vault completely over the cornea and rest on the sclera. This design not only shields the cornea from desiccation but also prevents mechanical friction from incomplete blinking or lid abnormalities. The fluid-filled reservoir beneath the lens serves to:

• Hydrate the corneal surface
• Promote epithelial healing
• Protect against environmental irritants
• Improve comfort and visual quality

By forming a barrier against external insults, scleral lenses are particularly useful in severe cases of exposure keratitis where conservative treatments, such as lubricating drops and ointments, prove insufficient.

Conditions Leading to Exposure Keratitis

What are some causes of exposure keratitis? Exposure keratitis can arise from a variety of underlying conditions that impair eyelid function or compromise corneal protection. An exhaustive list of conditions associated with exposure keratitis includes:

1. Facial Nerve Palsy (Bell’s Palsy): Paralysis of the facial nerve leads to incomplete eyelid closure.
2. Post-Surgical Eyelid Changes: After procedures such as blepharoplasty, ptosis repair, or tumor removal.
3. Proptosis (Eyeball Protrusion): Commonly seen in thyroid eye disease (Graves’ orbitopathy) or orbital tumors.
4. Cranial Nerve Disorders: Disorders affecting cranial nerves III and VII, leading to eyelid retraction or weakness.
5. Neurological Conditions: Examples include stroke, Parkinson’s disease, and myasthenia gravis.
6. Trauma: Mechanical injuries, burns, or scarring of the eyelids.
7. Dermatologic Conditions: Cicatricial changes from diseases such as Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or severe atopic dermatitis.
8. Lagophthalmos: Incomplete eyelid closure during sleep or blinking.
9. Congenital Anomalies: Eyelid coloboma or other developmental abnormalities.
10. Systemic Disorders: Conditions like ALS (Amyotrophic Lateral Sclerosis) that impair neuromuscular control of the eyelids.

In all these cases, scleral lenses play an essential role in mitigating the effects of exposure keratitis by maintaining corneal protection and addressing secondary visual issues.

Conclusion

Scleral lenses offer a solution for patients suffering from exposure to keratitis. By creating a fluid-filled barrier, these lenses protect the corneal surface, reduce symptoms of dryness and irritation, and promote healing. If you are interested in exploring scleral lenses as a treatment option for exposure keratitis, schedule a consultation with our team of experts at CLEI today to improve your vision, comfort, and most importantly, quality of life.