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Recurrent corneal abrasions – definitive treatment stops the pain

ByJohn A. Hovanesian, MD, FACS

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Case history: A 47-year-old patient reported to her optometrist with a spontaneous corneal abrasion occurring upon waking in the left eye. When the patient first opened her eyes in the morning, she described a “ripping” feeling on the surface of the eye and a sensation of the eyelid sticking to the eyeball. The exam showed an inferior, central 2-mm horizontal defect that responded with complete healing within 2 days of treatment with a topical antibiotic. Review of her history, however, revealed that the patient had several similar episodes in the past few months in the same location of the same eye.

Medical management: This patient had subtle signs of anterior basement membrane corneal dystrophy (ABMD). This common dystrophy of corneal epithelial cells leads to irregular basement membrane formation, resulting in the appearance of map lines, subepithelial dots and fingerprint patterns on the cornea (so-called “map-dot-fingerprint dystrophy”). The patient was treated with topical Muro 128 ointment (sodium chloride solution, Bausch + Lomb) at night and drops four times daily. After several weeks the patient continued to have symptoms of corneal erosions, and more definitive therapy was planned.

Surgical management: The patient underwent superficial lamellar keratectomy using a diamond bur and phototherapeutic keratectomy with an excimer laser. This 5-minute procedure involves removing all the loose surface epithelium (which comes off quite easily because of epithelial dysadherence) and roughening of the underlying Bowman’s membrane with a diamond burr. Subsequently, the excimer laser is used to remove just a few microns of Bowman’s membrane. This patient, after placement of a bandage contact lens and complete epithelial healing, which took a week or so, responded well with no further symptoms of erosions.

Summary:  Definitive surgical therapy for recurrent corneal erosions caused by ABMD is 95% successful in eliminating symptoms. For patients with recurring corneal breakdown due to anterior basement membrane dystrophy, this treatment can be life-changing.

Take-home message: Patients with recurrent corneal erosion should be referred for treatment, as definitive surgical intervention can most often eliminate symptoms and restore ocular comfort.