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Management of ocular surface exposure
  1. Carol Lane
  1. Correspondence to Carol Lane, Consultant Ophthalmologist, Cardiff Eye Unit, University Hospital of Wales, Cardiff CF14 4XW, UK; carollanedm{at}gmail.com

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Appropriate management of ocular surface exposure depends on understanding the pathogenesis in terms of the adnexal tissues, epithelial surfaces, motor and sensory innervation, tear film and sometimes the treatment. A primary aim of the oculoplastic surgeon is to protect the ocular surface and preserve vision. Proptosis, eyelid defects or immobility, eyelid malposition, impaired lacrimal gland secretion or drainage, meibomian gland dysfunction and reduced corneal sensation all compromise the ocular surface.

Static and dynamic assessment of the eyelids is a vital part of the anterior segment examination. A simple examination routine for all patients should include comparison of orbital symmetry, infrequency of blink, excluding the presence of lagophthalmos on blink as well as gentle and forced eyelid closure with a check for orbicularis weakness. A test for the presence, direction and extent of the Bell's phenomenon followed by slit lamp examination for eyelid margin entropion or other malpositions, trichiasis, punctal patency and meibomian gland disease helps identify vulnerable corneal zones for exposure or staining.

Types of ocular exposure

Static exposure

Static eyelid defects may be congenital, such as coloboma, or acquired, as in surgical sequelae, facial palsy, periocular burns and ocular cicatricial pemphigoid. The detail of eyelid structure is important. Workshops on meibomian gland dysfunction have produced a series of reports, indicating a wide range of types of meibomian gland size, position and secretion; the report of the diagnosis subcommittee is particularly informative.1 …

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