This guideline last updated 06/05/2022 17:39:57

Differential diagnosis

• Stroke
• Sarcoidosis
• Lyme disease
• Complication of Otitis media
• Trauma
• Tumour
• Ectropion
• Entropion
• Thyroid eye disease

Possible management by Optometrist

Treatment

• Tear supplements (lubricants by day, unmedicated ointment at night)
• Horizontally tape lids closed at night (and during day if corneal desiccation is marked and corneal sensation intact)
• Therapeutic contact lens (if unresponsive to frequent use of ocular lubricants)
  • Check corneal sensation is intact (do not use if impaired)
  • Silicone hydrogel should be considered as first choice (however, scleral lens gives maximum protection)
• Sunglasses for photophobia and general protection
• Urgent referral to GP for consideration of systemic steroids:
• Prednisolone 25 mg twice daily for 10 days, or
• Prednisolone 60 mg daily for five days followed by a daily reduction in dose of 10mg (for a total treatment time of 10 days), if a reducing dose is preferred

Advice

• Most cases resolve spontaneously within 9 months
• May respond to systemic steroids in the acute phase (first 3 days)

Management Category

• Urgent referral to GP for systemic steroids
• Normally no referral to ophthalmology
• Emergency (same day) referral if corneal ulceration present

Possible management by Ophthalmologist

• As above
• Upper lid lowering with botulinum toxin injection of levator muscle
• Surgery for permanently unrecovered cases
• External lid weights