exposure keratitis
Introduction
Introduction to exposed keratitis Exposure keratitis refers to various lesions of cleft palate incomplete, leading to corneal exposure and blink dyskinesia, and tears can not properly wet the corneal epithelial damage that occurs in the cornea. Clinical manifestations of corneal surface exposure, excessive tear evaporation, corneal epithelial dryness, blur, necrosis, shedding, ulceration or corneal epithelial keratinosis, accompanied by matrix infiltration and turbidity. Treatment includes medication and surgery. Patients with this disease are extremely unwell due to corneal exposure. At the same time as treating the primary disease, always pay attention to prevent corneal dryness. For example, before sleeping, be sure to apply a large amount of antibiotic eye ointment to prevent corneal dryness and infection. If necessary, the doctor can The eyelids are temporarily sutured, leaving the gap in the center of the cleft to see things, and keeping the keratoconjunctiva moist. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific people Mode of infection: non-infectious Complications: corneal ulcer
Cause
Causes of exposure keratitis
Disease factors (35%):
Exposure keratitis is a corneal inflammation that causes the cornea to lose its eyelid protection and is exposed to the air, causing dryness, epithelial shedding, and secondary infection. Common causes include: eyelid defect, eyeball protrusion, scar palitis, ptosis correction, upper sac retention and hernia closure, facial nerve palsy, deep anesthesia or deep coma.
Surgical anesthesia (30%):
During anesthesia, the eyelids are loosened due to the muscle relaxant effect of the anesthetic, eliminating the normal closure of the eyelids. If the operation is prolonged, the corneal exposure may cause exposure keratitis, and the patient may have photophobia, tearing, conjunctivitis and foreign bodies. The local eye pain of the sense, so take appropriate eye protection measures after anesthesia.
In general anesthesia, coma or failure, the cornea loses consciousness, blink reflex disappears, functional stenosis can also occur, due to corneal surface exposure, tear evaporation is too fast, corneal epithelium is dry, rough, necrotic, ulcer or cornea Epithelial keratinosis with matrix infiltration and turbidity. Due to the loss of corneal sensation, the invasion of foreign matter such as dust in the operating room cannot be blocked, and it is easy to damage, and even secondary bacterial and fungal infections.
Iatrogenic injury (28%):
During the head and face surgery, the shadowless lamp continues to illuminate. The strong light and the heat it radiates easily lead to the dryness of the cornea. In addition, the intraoperative sterile dressing wraps the head tightly, the operation time is too long, and the friction is generated during the operation to make the sterile dressing. Fibrin debris falls off, causing damage to the exposed cornea, resulting in dry corneal surface, epithelial shedding, conjunctival hyperemia, and exposure keratitis.
Prevention
Exposure keratitis prevention
Patients with this disease are extremely unwell due to corneal exposure. At the same time as treating the primary disease, always pay attention to prevent corneal dryness. For example, before sleeping, be sure to apply a large amount of antibiotic eye ointment to prevent corneal dryness and infection. If necessary, the doctor can The eyelids are temporarily sutured, leaving the gap in the center of the cleft to see things, and keeping the keratoconjunctiva moist.
Complication
Exposure keratitis complications Complications corneal ulcer
If the disease is not treated promptly or improperly treated, it can cause black eyes to burst, and yellow kernels sprout out, forming a crab eye disease, that is, the cornea is broken, the iris is prolapsed, and the visual acuity is seriously impaired or even blind.
Symptom
Exposure keratitis symptoms common symptoms corneal opacity conjunctival edema and corneal ulcer secondary infection
Due to the exposure of the corneal surface, the tears evaporate too fast, the corneal epithelium is dry, blurred, necrotic, shedding, ulceration or corneal epithelial keratinosis, accompanied by matrix infiltration and turbidity. If the degree of cleft palate is less severe, or because of the upward relationship of the eyeball when closing the eye (Bell phenomenon), only one-third or less of the part is exposed, the corneal damage is also limited to this part, due to corneal perception. Reduced, the invasion of foreign bodies can not reflect and block, so it is easy to damage, and even secondary bacterial and fungal infections.
In the case of incomplete closure of the eyelids, the exposed corneal surface becomes dry due to the acceleration of evaporation of the liquid, resulting in severe infiltration and ulceration. This disease has no secondary infection and is generally only grayish white with no sharp changes. There is also no purulent phenomenon.
Examine
Examination of exposed keratitis
Combined with medical history, the general corneal visual examination, photocopying method and Placido disc examination method, corneal staining method, etc. were used to check the corneal lesions.
Diagnosis
Diagnosis and differentiation of exposed keratitis
Diagnose based on:
1. Eyelid closure caused by various reasons, corneal exposure.
2. Exposed cornea, conjunctival dryness, corneal epithelial shedding or even ulceration. Conjunctival xerosis (conjunctival xerosis) is a phenomenon of conjunctival dryness mainly due to lesions of the conjunctival tissue itself, for a variety of reasons. Under normal circumstances, tears secreted by the lacrimal gland and conjunctival goblet cells keep the conjunctiva constantly moist, and once the above-mentioned moisturizing function is destroyed, conjunctival dryness occurs. Conjunctival dryness can be divided into epithelial conjunctival xerosis and substantial conjunctival xerosis.
