Eyeworld

86 | EYEWORLD | SPRING 2026 C ORNEA EBMD changes, and in the bad eye, you'll see a big scratch and very loose epithelium, and you're not sure why it's there. Early treatment options For treatment options, Dr. Rapuano said it depends on how bad the symptoms and exam findings are, and he often takes a stepwise approach. If they have a large corneal abrasion, you need to treat it with antibiotics to prevent an infection, he said. If the patient is in a lot of pain or has a bad epithelial defect, a bandage contact lens can be used temporarily with anti- biotic coverage. If the epithelium is sloughing off or is so loose that it's barely hanging on, you can do an epithelial debridement, Dr. Rapuano said. This helps to remove all the non-adherent epitheli- um. Sometimes you can use a pressure patch, but usually either antibiotic ointment or a ban- dage lens will help the patient heal. If you can get them to heal, you want to then use preven- tative treatments to keep it from coming back. To prevent this from recurring, keep the eye lubricated during the day, but the key thing is to use some type of lubricating or antibiotic ointment at night. This involves ointment/gel between the eyelid and the eyeball so that the eyelid can't pull on the loose epithelium. Over weeks to many months, Dr. Rapuano said, the epithelium lays down its proper cement, and ideally it doesn't happen again. He recommends using ointment every night for 6 months, in- cluding if taking a nap. While these instructions are simple, the routine can still be challenging. If this preventive treatment doesn't work, Dr. Rapuano said there are other options. One option is a bandage soft contact lens that you put in the eye for about 6 months, replacing every month or two. The disadvantage of that is the extended wear does increase the chance of infection, he said, adding that infection may cause significant scarring. Dr. Chamberlain also noted the many conservative treatment options to start these patients on, beginning with topical lubrication and nighttime ointments, including hypertonic saline ointment, bandage soft contact lens ther- apy, topical antibiotics to prevent infection in overt epithelial breakdown, and oral antibiotics such as doxycycline and tetracycline, which may reduce matrix metalloproteinase activity. Other available options might include autologous serum drops, amniotic membranes, and careful use of low potency topical corticosteroids, he said, which may also reduce inflammation asso- ciated with and causative of erosions. Advanced treatment options When conservative treatment options fail, as Dr. Chamberlain noted they do in more than 50% of cases, surgical options include superficial ker- atectomy with diamond burr polishing (DBP), anterior stromal puncture (ASP), alcohol de- lamination/removal of epithelium, and excimer laser phototherapeutic keratectomy (PTK). ASP creates focal stromal scars using a bent needle to enhance epithelial adhesion, he said, adding that the PTK approach uses excimer laser ablation to remove abnormal basement membrane and create a smooth surface for epithelial regeneration. Treatment for EBMD and recurrent corne- al erosions typically begins with conservative measures and escalates to surgical interventions when medical therapy fails, Dr. Chamberlain stressed. He added that treatment choice de- pends on lesion location, severity, recurrence continued from page 84 Central map and dot epithelial basement membrane dystrophy changes Source: Christopher J. Rapuano, MD

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