The Ophthalmic Office Procedures Handbook

SECTION 5 Cornea and Conjunctiva

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Epithelial Basement Membrane Dystrophy ● Poor epithelial layer attachment because of abnormal basement membrane structure causes higher risk of RCE, symptoms of intermittent blurred vision, and ocular surface discom fort. 5 In the context of preoperative cataract surgery consideration, untreated or undiag nosed EBMD can result in inaccurate intraocular lens (IOL) calculations and postoperative corneal healing issues. 3 ● The goal of corneal debridement in EBMD is to remove the unhealthy or poorly adhered epithelium, optimize the Bowman’s layer, and allow regeneration of new firmly attached epithelial tissue for a healthy and smooth ocular surface. 1,3 Inclusion criteria for studies reporting on this procedure for EBMD include negative fluorescein staining within the central 6 mm of the cornea, suggestive patient symptoms, and/or measurable astigmatism attributable to the corneal surface. 2 Recurrent Corneal Erosions ● This condition is characterized by a recurring disruption of epithelial attachment to the underlying Bowman’s layer. Trauma and corneal dystrophies such as EBMD are the most common etiologies. 1,5 ● Treatment goals are similar to EBMD. Some studies have also reported good success with anterior stromal puncture performed simultaneously with corneal debridement, including with visual axis involvement. 2,6 Salzmann Nodular Degeneration ● Salzmann nodules appear as blue/white-gray nodules formed anterior to Bowman’s layer with thinned and defective overlying epithelium. The basement membrane is disrupted, leading to irregular proliferation, migration, and deposition of disorganized extracellular matrix at the basement membrane and Bowman’s layer junction. 7,8 Salzmann nodular de generation often coexists with EBMD and is also associated with post-LASIK, other ocular surface diseases, and Crohn’s disease in recurring bilateral cases. It is also associated with Meibomian gland dysfunction in up to 53% of cases. 2,7,8 ● Treatment goals of corneal debridement aim to remove the nodules, restore healthy epithe lial tissue, improve ocular surface comfort, and stabilize fluctuating refractive error changes. Infectious Keratitis ● Corneal debridement in infectious keratitis can be in both a diagnostic and therapeutic ca pacity. In corneal ulcers that are large, chronic, extending into the deeper stroma, unrespon sive to empirical therapy, or suspicious of fungal or amoebic activity, corneal culturing is imperative. Debridement allows the removal of epithelial layers for proper tissue sampling. 4 ● Poor healing epithelium in a slow-healing corneal ulcer or active viral infection, such as Herpes simplex dendritic keratitis, may benefit from having devitalized tissue removed to promote healing. 4 This must be performed with appropriate therapeutic antimicrobial treatment under close observation.

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