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Persistent corneal ulcers. What to do when ulcers won't heal
1Department of Ophthalmology, Medical College of Wisconsin, Milwaukee.
Summary
Differentiating primary versus secondary causes of persistent corneal erosions is crucial for effective treatment. Various medical and surgical options exist to manage these challenging nonhealing corneal conditions.
Area of Science:
- Ophthalmology
- Corneal Disease
- Ocular Surface Disease
Background:
- Persistent corneal erosions can stem from primary corneal issues like epithelial basement membrane dystrophy (EBMD) or secondary causes including KCS, infection, or adnexal disease.
- Accurate diagnosis is essential to guide appropriate therapeutic interventions for nonhealing corneal erosions.
Purpose of the Study:
- To outline the differential diagnosis between primary and secondary causes of persistent corneal erosions.
- To review available medical and surgical treatment modalities for managing nonhealing corneal erosions.
Main Methods:
- Review of primary corneal diseases leading to nonhealing erosions, including EBMD and endothelial dystrophies.
- Discussion of secondary causes such as keratoconjunctivitis sicca (KCS), infections, and adnexal diseases.
- Overview of therapeutic options: debridement, contact lens therapy, superficial keratectomy, punctate keratotomy, hyperosmotic agents, and novel drugs (EGF, fibronectin, aprotinin).
Main Results:
- Successful management hinges on correctly identifying the underlying etiology of the persistent corneal erosion.
- A broad spectrum of treatments, from conservative to surgical, can be employed based on the diagnosis.
Conclusions:
- Distinguishing between primary corneal conditions and secondary factors is key for successful treatment of persistent corneal erosions.
- A range of medical and surgical interventions are available to address these challenging ocular surface problems.