Exposure Keratitis and Dry Eye

Medically Reviewed by Whitney Seltman, OD on June 21, 2021

Every time you blink and when you fall asleep at night, your eyes should close all the way. When they're shut, your tears keep the surface moist. This helps your eyes stay clean and healthy.

But if your lids don't close all the way, a portion of your eye is exposed to the air. That can lead to dry eye from a problem called exposure keratitis. It can make your eyes hurt and cause infection, swelling, and vision problems.

What Causes It?

There are several reasons why your eyes might not shut all the way when you blink or sleep. They include:

  • Bell's palsy or other types of facial paralysis
  • Past damage to your eyelids
  • Past eyelid surgery or scar tissue on the eyelids
  • Drugs that sedate you (like anesthesia)
  • Side effects from Botox injections

It's hard for the eyelids to fully close when your eyes bulge out due to:

  • Thyroid disease
  • Cushing's syndrome
  • Grave's disease

Your lids may not close all the way if you blink with less force because of problems like:

  • Nerve damage
  • Parkinson's disease
  • Other nervous system problems


What Are the Symptoms?

If your eyelids don't close fully, you may have these dry eye symptoms. They're often worse in the morning, after you wake up:

  • Eye pain, burning, or redness
  • Feeling like you have bits of dirt or sand in your eye
  • Blurry vision
  • Trouble reading for long periods of time
  • Tired eyes
  • More tears than usual
  • Sensitivity to light


How Is It Diagnosed?

The doctor will ask about your symptoms and your medical history. They'll examine your eyelids to see if they close all the way and if you're blinking well. They'll also check your eyes for damage from dryness.

They may put drops in your eyes that highlight damaged areas when they look at them with a special light. Most damage affects the bottom third of your eye. This is the area that isn't covered when your lids don't fully close.

What's the Treatment?

Your doctor may suggest:

  • Drops or ointments. These keep your eyes moist, which eases the problem. You might need to use artificial (fake) tears several times a day. The doctor might give you an ointment or gel to use at night. The meds have long-lasting effects and keep your eyes from drying out overnight, even if they don't close all the way.
  • Special glasses. Your doctor may have you try a special eyewear called moisture chamber glasses. They're like a mix of glasses and goggles. They surround and enclose your eyes and keep out the air. So it takes longer for your tears to dry out.
  • Antibiotics. If your eyes get too dry, bacteria can cause an ulcer or infection on the surface (cornea). If this happens, your doctor will prescribe antibiotic eye drops or ointment to cure it.
  • Lid-closing methods. Your doctor may put something over your eyes to help them stay shut. They might tape your lids shut or apply patches or gauze dressings. If they want you to do this every night, they'll show you how. They'll probably have you put ointment or gel in your eyes before you secure your lids.
  • Surgery. Sometimes surgery is the only way to get your eyelids to close like they should. The doctor can lower an upper lid, raise a lower lid, or tighten a droopy one. It's rare, but sometimes the lids need to be sewn shut for a while so your eye can heal. Your doctor will know what treatment is right for you.


Can You Prevent It?

You may not be able to change the way your eyelids close. But you can use artificial tears and gel or ointment at night to keep symptoms or vision changes at bay. See your doctor regularly to make sure your eyes stay healthy.

WebMD Medical Reference



American Academy of Ophthalmology: "Exposure keratopathy," "Management of exposure keratopathy."

University of Michigan Health System Kellogg Eye Center: "Exposure keratopathy."

Ophthalmic Plastic & Reconstructive Surgery: "Myobloc for the treatment of benign essential blepharospasm in patients refractory to botox."

National Eye Institute: "Facts about dry eye."

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