Inferior SPK is a common presenting sign of exposure keratopathy.

Inferior SPK is a common presenting sign of exposure keratopathy.

• A. Inferior SPK is a common presenting sign
• B. Superior SPK is a common presenting sign
• C. Central corneal thinning
• D. No fluorescein pooling

Answer: (A)

Exposure keratopathy happens when the corneal surface isn’t adequately protected by the eyelids, so the tear film dries and the epithelium becomes damaged. The inferior part of the cornea is the most exposed when eyelid closure is incomplete, and also where tears tend to pool and evaporate first. This leads to superficial punctate keratitis that fluorescein stains in the inferior cornea, making this pattern a characteristic presenting sign. The pattern you see here is less typical for a superior-affected cornea, and central thinning points to other conditions. Fluorescein pooling isn’t the defining feature; the key clue is the inferior punctate staining from surface drying.

Exposure keratopathy happens when the corneal surface isn’t adequately protected by the eyelids, so the tear film dries and the epithelium becomes damaged. The inferior part of the cornea is the most exposed when eyelid closure is incomplete, and also where tears tend to pool and evaporate first. This leads to superficial punctate keratitis that fluorescein stains in the inferior cornea, making this pattern a characteristic presenting sign. The pattern you see here is less typical for a superior-affected cornea, and central thinning points to other conditions. Fluorescein pooling isn’t the defining feature; the key clue is the inferior punctate staining from surface drying.