Corneal epithelial defect

The eight most severely injured patients (15%) with Grade IV injuries had gross scarring, vascularization, and a permanent severe reduction in vision, bilateral in one case [22]. There were two cases of infectious keratitis with Staphylococcus aureus in patients with persistent corneal epithelial defects this progressed to globe perforation in one case. One patient underwent... 

A 15-year-old boy felt a foreign body sensation in his right eye after he had been raking hay. His local physician prescribed a suspension of tobramycin 0.3% + dexamethasone 0.1% tds, but 6 days later referred him for evaluation of a suspected fungal keratitis. He had a corneal epithelial defect with an underlying dense... 

Cases of the crack eye syndrome continue to be reported. Of 14 crack cocaine users with corneal problems, 10 had corneal ulcers infected with both bacterial and fungal organisms 4 had corneal epithelial defects (161). All were actively smoking crack daily. The authors suggested that crack smoking predisposes users, through an unknown mechanism, to corneal epithelial changes, infection, and perforation. Typical presentations include loss of vision with or without pain. 

Tetracycline and doxycycline are metalloproteinase inhibitors and when given orally can block the action of corneal collagenases. Either may be effective for resolving noninfected corneal ulcers or corneal melting in which progressive necrosis of stromal tissue occurs despite the absence of a positive culture. Similarly, the anticollagenolytic activity of tetracycline or doxycycline can prove clinically useful in treating persistent corneal epithelial defects. 

Some practitioners prefer not to recommend the use of therapeutic soft contact lenses during episodes of bullae eruption. When a patient presents with corneal epithelial defects due to ruptured bullae, a prophylactic antibiotic ointment such as 0.3% tobramycin or 0.3% ciprofloxacin four times a day can be administered, along with a cycloplegic agent (e.g., 5% homatropine two times a day). 

Topical fluorescein dye is often used during slit lamp examination, because it helps in identifying corneal epithelial defects (1). Fluorescein retinal angiography was first described in 1961 (2) rapid intravenous injection of fluorescein displays retinal circulation velocity and the fine architecture and integrity of the blood retinal barrier. This is associated with minor adverse events in 21% of cases and potential life-threatening adverse events in 0.5% (3). 

An elderly man underwent vitreoretinal surgery for retinal detachment. Perfluorodecahn was used to repair the retina and was left in situ for 8 weeks and removed via the pars plana. One month later he developed a non-healing corneal epithelial defect associated with limbitis. Perfluorodecahn was found under the superior conjunctiva. A biopsy showed vacuoles in the conjunctival stroma surrounded by inflammatory cells. On surgical removal of the perfluorodecahn from the subconjunctival space, the epithelial defect healed. 

Voltarol Ophtha postoperative inflammation and pain in corneal epithelial defects... 

Donnenfeld, E.D., Perry, H.D. and Nelson, D.B. (1991) Cy anoacrylate temporary tarsorrhapy m the management of corneal epithelial defects. Opht. Surg., 22, 591-593. 

Observational studies The short-term and long-term safety of topical bevacizumab 5 mg/ml for progressive corneal neovascularization secondary to a variety of corneal diseases and not responding to conventional anti-inflammatory treatment have been evaluated in 30 eyes of 27 patients Five patients (five eyes) developed new corneal epithelial defects. The authors warned against using bevacizumab in patients with epithelial defects and neurotrophic keratopathy. There were no allergic reactions, ocular drug-related complaints, or systemic adverse reactions. 

INFLUENCE OF CHRONIC ALCOHOLIC INTOXICATION ON HEALING OF CORNEAL EPITHELIAL DEFECTS. EFFECTIVITY OF TREATMENT BY PROTEASE INHIBITOR CONTRYCAL (APROTININ) AND AUTOLOGOUS FIBRONECTIN... 

We observed 23 patients (23 eyes) with persistent corneal epithelial defects after previously endured eye traumatic injuries. These injuries were caused by metal shaving or chemical reagents and were obtained during production and everyday activity of the patients. Treatment was carried out by traditional medicaments and ways (local use of antibacterial and antiviral ophthalmic solutions, solcoseril) but was not effective during 3-4 weeks. 

Activity of plasmin-like enzymes of tear of healthy patients with intact cornea was 50.72 + 7.73 AU. At the first day of observation the activity of lacrimal plasmin-like enzymes of patients with corneal epithelial defects in the control group increased more than 4 times and was 234.5 19.0 AU. These data did not significantly differed from the data obtained for the patients from the first experimental group (249.0 21.5 AU) (table 1). On the contrary, the activity of lacrimal plasmin-like enzymes in patients who had small and strong drinks during the time of the present study (second group) increased almost 1.5 time and was 352.6 24.2 AU (p < 0.01). 

Berman M.B., 1989, The pathogenesis of corneal epithelial defects, Acta Ophthalmol (Copenh.)(Suppl). 192, 67 55. 

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