This article is more than 5 years old. Information may no longer be current.
Managing recurrent corneal erosion runs gamut from artificial tears to PTK
Click Here to Manage Email Alerts
JACKSONVILLE, Fla. — Managing recurrent corneal erosion is clearly a double-edged sword.
"It is one of the most satisfying and one of the most frustrating things that an optometrist does for his or her patients," said Louis J. Catania, OD, in private group practice here. "It's satisfying because patients who suffer recurrent corneal erosion are usually in an enormous amount of discomfort and despair over the fact that they may never get better. The treatment is as much psychological as it is physical."
--- The first approach to treating recurrent corneal erosion is prescribing artificial tears or a temporary antibiotic.
The disorder is rarely resolved with the first regimen. "You need to start with milder therapies and then move on to more aggressive therapies. Each time, though, the patient is recurring, suffering and becoming more doubtful as to whether the next level of care will work, because the previous two or three have not," said Dr. Catania, author of the book Primary Care of the Anterior Segment which includes discussion on recurrent corneal erosion.
In fact, patients may become skeptical of the OD's professional judgment. Therefore, "You must keep both a positive and realistic attitude," Dr. Catania noted. "Most patients will eventually respond to some form of therapy. It just takes time to get through the process."
Conservative treatments
The mildest approach is to treat the disorder as a simple corneal abrasion, prescribing artificial tears or a temporary antibiotic, followed by weeks or even months of hypertonic saline ointment at bedtime. "You don't want to leave the patient on an antibiotic indefinitely because of toxicity," Dr. Catania said.
The second level of care also involves a temporary antibiotic, along with perhaps a therapeutic soft contact lens. "In general, practitioners find that the disposable soft lenses are the most effective," Dr. Catania explained.
"These lenses fit the eye loosely enough so that they don't create any secondary physiological insult." In addition, disposable lenses minimize infection, and the cost is nominal.
Pressure bandages are also an option; however, "they have come into serious question," said Dr. Catania, because of the risk of secondary infection.
Regardless, "the use of a pressure bandage is often of value in cases when the erosion goes down to the basement membrane," he said. "The bandage tends to press the cells down a little more firmly and reduces the potential for recurrence."
The aggressive use of ointments instead of drops is also helpful at all these levels of care, other than when the patient is actually wearing a soft lens bandage. "Ointments tend to smooth the surface," said Dr. Catania, singling out hypertonic saline ointment.
Aggressive treatments
The fourth step of therapy is anterior stromal puncture (ASP), using about a 25-gauge needle. "The very tip is bent to create a tiny microbend which is used to accomplish the procedure," said Randall K. Thomas, OD, a specialist in the treatment of eye disease in private group practice in Concord, N.C.
"ASP is a very safe and effective technique. It is considered 'curative' in the vast majority of patients," Dr. Thomas said. The simple therapy usually consists of 40 to 60 micropunctures into the anterior one-fourth of the corneal stroma and takes about 1 minute to perform.
"This micropuncture technique alters the tissue biochemistry, which results in a tighter binding of the epithelial cells to the basement membrane and to Bowman's layer," Dr. Thomas said.
The fifth and most aggressive form of treatment is corneal debridement or phototherapeutic keratectomy (PTK). The former, "is extremely cost efficient," said Dr. Thomas. On the other hand, PTK "is very expensive and accomplishes the same goal — debriding the cornea."
However, in either case, "there are several days of painful recovery."
The good news is there is a well-recognized stepped approach which can be curative in almost all patients.
For Your Information:
- Louis J. Catania, OD, is a clinical consultant in Jacksonville, Fla. He can be reached at 2279 Seminole Road, No. 4, Atlantic Beach, FL 32233; phone/fax: (904) 247-8934; e-mail: lcatania@aol.com.
- Randall K. Thomas, OD, is in private group practice. He can be reached at 6017 Havencrest Ct., Concord, NC 28027; phone/fax: (704) 792-1647. Neither Dr. Catania nor Dr. Thomas has a financial interest in any of the products mentioned in this article, and neither is a paid consultant for any of the companies mentioned.