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Eye problems from poor eyelid closure / exposure keratopathy - A State of Sight #115

Proper eyelid function is very important to maintain the health of the eye. If the eyelids do not close or blink appropriately, the cornea can be exposed and become irritated.

Watch this episode of A State of Sight with Isaac Porter, MD to learn more about the cause of inadequate eyelid closure and some of the potential treatments.




Welcome to A State of Sight. I’m Isaac Porter, MD and this is your update in ophthalmology and eye care from Raleigh. Today, I would like to explain the problems that can occur when the eyelids are not functioning properly to cover the eye.


Normally, about one-sixth of the eyeball is exposed to the air in the front of the eye when the eyelids are in a good position. The lids need to work properly in order to distribute the tear film smoothly over the eye and to cover the eye completely when the eyelids are closed.


If this closure does not occur, it can result in eye irritation and dryness. There can be problems with the cornea including exposure (exposure keratopathy) where the surface can become very rough. It can also lead to ulceration, infection, or in severe cases, perforation of the cornea.


There are multiple reasons that the eyelids may not function normally. If there is a problem with the 7th cranial nerve (the nerve that controls the facial muscles), the eyelids may not close completely or blink fully. This can occur after surgery, from an injury, or from Bell’s palsy. The facial nerve also helps the eye produce tears, so the eye can become even more dry and irritated from poor natural tear production in addition to corneal exposure.


In some patients, their eyes may not close fully overnight when they are sleeping. Interestingly, this can occur in multiple members of the same family. If the eyelids are retracted or further back then they should be, exposure can result as well. This can be from Graves’ disease or prior eyelid surgery where the lids have been raised or separated too much.


With milder cases of eye irritation from exposure, some of the treatments that we like to use are regular artificial tears or thicker tears like a gel drop. People that have trouble overnight may use ointment to help lubricate their eyes better when they are sleeping. They can also consider taping their eyelids closed which can be bothersome but very effective.


Another choice is a moisture chamber, created by a thin piece of cellophane or plastic to make a seal around the socket. This can help keep moisture and lubrication inside the eye and be better for the surface.


Beyond this, some patients may need to consider surgery to help improve the position or the function of their eyelids. This can include closing the eyelids either temporarily or permanently with sutures at the sides (tarsorrhaphy). Alternatively, a gold weight can be placed in the upper eyelid to help it close better.


If you have any questions about corneal exposure or problems from poor eyelid function, please post and we will be happy to answer them. We hope to see you again soon next time on A State of Sight.

Give us a call at 919 876 4064 to schedule an evaluation if you feel that your eyes are irritated or your vision is blurred from any of these problems!