Eyeworld Daily News

22 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS as an office procedure and protects the cornea from eyelid trauma and encourages epithelial regrowth and adhesion. But it's expensive and may not always be covered by insurance, she said. If medical therapies don't work and you must move on to surgi- cal options, Dr. Trinh said several options can be done in a minor pro- cedure room. In conclusion, Dr. Trinh said that a history is important in these recur- rent corneal erosion cases because signs can be subtle. She stressed the importance of looking at the inferior portion of the corneal for recurrent corneal erosion trauma sites, looking underneath the upper lid for EBMD changes, and looking at the keratome incision site if post cataract surgery. She said it's key to exhaust medical options before turning to surgical options, and she said treatment of ocular rosacea and dry eye disease is just as important as the erosion itself (otherwise you risk ongoing degradation). Editors' note: Dr. Trinh has financial interests with Alcon, Teleon, and AbbVie. even after testing, so Dr. Trinh suggested using the corneal sweep test from D. Brian Kim, MD. OCT and confocal microscopy could also be helpful to look for changes and evidence of these recurrent corneal erosions. Medical management options include lubrication, patching, and hypertonic saline; bandage contact lens; MMP inhibitors; autologous serum tears; and corneal growth factor isolates. Surgical management options include anterior stromal puncture; YAG laser stromal micro- puncture; alcohol delamination; superficial keratectomy with or without diamond burr polishing; phototherapeutic keratectomy; and Botox tarsorrhaphy. Many patients respond initially to the medical option of lubrication, patching, and hypertonic saline, Dr. Trinh said, but you often need more. Bandage contact lenses can be a good option, with symptom reduc- tion and low recurrence, but there is also a risk for infection. MMP inhib- itors can also be used. Autologous serum tears are a good second line therapy, she said. Dr. Trinh noted that amniotic membrane therapies can be a good option because it's easy D uring a Cornea Day session on office-based corneal disease management, Tanya Trinh, MD, presented on recurrent corneal erosions. A recur- rent corneal erosion is defined by a dysfunctional epithelial ecosystem and biology. It's not just a structural derangement, and she said corneal neuropeptides also play a key role. This is caused by poorly adher- ent epithelium that is avulsed off Bowman's layer by eyelid opening or REM sleep. The time from inciting trauma to symptoms onset is vari- able. This can be due to a number of origins, but Dr. Trinh noted that is oc- curs most from trauma (fingernails, occupational trauma, or organic mat- ter), and second most from EBMD/ corneal dystrophy. Symptoms are chronic and relapsing. It's usually sudden onset lacrimation, eye pain, photophobia, and typically in the early morning upon awakening. These episodes can last from minutes to days, she said. To look for recurrent corneal ero- sion, Dr. Trinh suggested using the slit lamp, fluorescein staining, and retroillumination. She noted that microform lesions are small epi breaks, which usually resolve within 4 hours and are absent on exam. These resolve quickly but recur frequently. Macroform lesions, on the other hand, are large epi breaks (large areas of loose, absent cornea) and are painful for days. She said to look for greyish staining areas of the epithelium on the slit lamp. Dr. Trinh said to look for EBMD, to be sure to lift the upper lids. Things could still appear normal, Managing corneal disease in the office "It's key to exhaust medical options before turning to surgical options [when dealing with recurrent corneal erosions]." –Tanya Trinh, MD

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