Date of last review: Due to be updated

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