Four children developed exposure keratitis of various degrees of severity while being mechanically ventilated for control of intracranial pressure. All had been paralyzed with pancuronium and sedated with morphine to facilitate ventilation. Pathophysiology of this keratitis involves subtle and undetected incomplete eyelid closure which chronically exposes the inferior one-third of the cornea. Prevention by frequent application of ocular lubricants and taping of the eyelids is recommended.