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  • AAO 2018 Daily

    A Stepwise Approach to Healing Stubborn Corneal Wounds


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    Infection, poor tear film, and eyedrop toxicity can all prevent corneal wound healing. Resolving these persistent epithelial defects can be tricky, said Ali R. Djalilian, MD. He outlined a stepwise approach to managing patients as part of the Hot Topics of the Ocular Surface session at AAO 2018.

    Step 1

    • Begin with imaging studies and perform cultures to rule out infection.
    • As a first-line treatment, apply preservative-free lubricants frequently.
    • Minimize the toxic burden of any drops the patient is currently taking.
    • A soft bandage lens should be worn continuously.
    • Consider oral doxycycline, punctal occlusion, and a pressure patch or moisture chamber with plastic wrap.

    Step 2

    • If the first-line measures don’t resolve the wound, consider treating with autologous serum or platelet-rich plasma. Concerns about the presence of inflammatory mediators in serum are outweighed by the benefits—except in patients with preexisting inflammatory conditions.
    • Consider a nonsutured biological bandage crafted from human amniotic membrane. These last about 1 week, however, and may be less effective in patients with severe or prolonged defects, which may take longer to heal and require multiple reapplications.
    • Multiple layers of a sutured amniotic membrane graft may be needed if the patient shows signs of stromal loss.

    Step 3

    • If all else fails, prescribe a scleral contact lens to be worn continuously during the daytime, switching to a soft lens at night.
    • As a last resort, consider performing a tarsorrhaphy, conjunctival flap, or corneal/limbal stem cell transplant. —Anni Griswold

    Financial disclosures. Abbvie: C; Novartis, Alcon Pharmaceuticals: C; Vomaris: C.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.

    Next story from AAO 2018—Monitor Patients With Primary Angle Closure Carefully After Laser Iridotomy: Laser peripheral iridotomy (LPI) increases angle width in all stages of primary angle closure (PAC) and is relatively safe, according to Sunita Radhakrishnan, MD.