How does exposure keratitis develop when the eyelids cannot close fully?

Exposure keratitis develops when the cornea becomes dry and inflamed because the eyelids cannot close completely. This inability to shut the eyes fully is typically caused by the protrusion of the eyeball or paralysis of the muscles responsible for eyelid movement.1

When the eyelids fail to provide proper coverage, the eye surface is chronically exposed, which alters tear film dynamics and leads to excessive dryness. Because the cornea relies on adequate moisture to remain healthy, this persistent exposure leaves it vulnerable to inflammation and potential damage. Initial management of this condition focuses on aggressive lubrication of the eye; however, if these measures are insufficient, medical intervention—such as closing the eyelid puncta or performing surgery to partially close the lids—may be required to protect the corneal surface.12