Patient history, exam key to treating persistent epithelial defects
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WASHINGTON — Ophthalmologists need to look and listen for the cause of persistent epithelial defects, according to a speaker here.
“When we think about this problem, we have to think about the contributors to the problem,” Winston D. Chamberlain, MD, PhD, ABO, said at the American Society of Cataract and Refractive Surgery meeting. “I think about lids and external adnexa, primary epithelial disorders and corneal nerve disorders.”
Reviewing patient medications and taking a thorough history are important to the process, he said. When performing an exam, physicians should pay close attention to facial and eyelid anatomy, blink function and frequency, lagophthalmos and ocular surface features. In addition, ophthalmologists should check for sensation with a cotton wisp or nylon fiber if possible.
When addressing primary epithelial disorders, Chamberlain said that it is important to reduce the surface toxicity of drops, use preservative-free drops, consider stopping medications in cases of anesthetic abuse, treat potential infection and perform superficial keratectomy when appropriate.
“The amniotic membrane plays a large role in getting these epithelial defects to close rapidly, although sometimes the long-term effect of this is not sustained,” he said. “If they have edema, we have to think about treating the underlying endothelial disorder.”
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Chamberlain WD. Best stepwise approach to treat persistent epithelial defect. Presented at: American Society of Cataract and Refractive Surgery meeting; April 22-26, 2022; Washington.
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