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In open quantum systems hosting excitons, dissipation mechanisms critically shape the excitonic dynamics, band-structure and topological properties. A microscopic understanding of excitons in such non-Hermitian settings demands a first-principles generalization of the Bethe-Salpeter equation (BSE). Building on a recently introduced nonequilibrium Green’s function formalism compatible with Lindbladian dynamics, we derive a non-Hermitian BSE from diagrammatic perturbation theory on the Keldysh contour, and obtain a microscopic excitonic Hamiltonian that incorporates dissipation while preserving causality. We apply the formalism to valley excitons in transition metal dichalcogenides coupled to structured photon baths. We uncover a rich landscape of exceptional points in momentum space, forming either discrete sets or continuous manifolds, depending on bath structure. The exceptional points give rise to non-analytic valley-polarization, unusual polarization pattern in photoluminescence, and nontrivial topological signatures. Our results establish a first-principles framework for predicting and controlling excitonic behavior in open quantum materials, showing how engineered environments can be leveraged to induce and manipulate non-Hermitian and topological properties.