• A Stepwise Approach to Healing Stubborn Corneal Wounds


    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.

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