Persistent Epithelial Defects
Usually, the epithelial defect created during surface ablation heals within 3 or 4 days with the aid of a bandage contact lens. A frequent cause of delayed reepithelialization is keratoconjunctivitis sicca or other tear film abnormalities. Proper diagnosis and targeted treatment are critical. Treatment options include aggressive nonpreserved lubrication, topical cyclosporine, temporary punctal occlusion, amniotic membrane grafting, and autologous serum drops. Patients who have autoimmune connective tissue disease or diabetes mellitus or who smoke may also have poor epithelial healing and may require a more aggressive approach. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) should be discontinued in patients with delayed reepithelialization. Nonpreserved drops are preferable. Oral tetracycline-family antibiotics may be beneficial for persistent epithelial defects because they inhibit collagenase activity and in turn improve wound healing. In some cases, epithelial healing may be impaired by the presence of necrotic epithelium on the corneal surface. Gentle debridement of the necrotic epithelial border can promote reepithelialization. The importance of closely monitoring patients until re-epithelialization occurs cannot be overemphasized, as a persistent epithelial defect increases the risk of corneal haze, irregular astigmatism, refractive instability, delayed recovery of vision, and infectious keratitis.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.