Corneal epithelial basement membrane dystrophy: an overlooked cause of painless visual disturbances

Although decreased vision from corneal epithelial basement membrane dystrophy (CEBMD) usually is associated with pain from corneal epithelial erosion, it may be an overlooked cause of painless, sometimes sudden, visual disturbance. We report a series of eight patients referred to our department with visual deficits for whom various diagnoses had been made. A total of 15 neurologic and ophthalmologic tests had been ordered before their referral. All patients had CEBMD as a cause for their visual deficit. Retroillumination through a dilated pupil and examination of the fluorescein tear film were the best methods to demonstrate the CEBMD. Six of the eight patients underwent epithelial debridement with complete resolution of their symptoms. We recommend that all patients with unexplained visual disturbances be examined closely for CEBMD.