- Causes: epithelial cell loss during storage, surface trauma intra-operatively,
eye rubbing, lid malposition or medication toxicity.
- Normally, the defect will re-epithelialize by the dividing and migrating
host epithelium from the limbus within a week.
- Clinical features:
- Minimal to significant loss of corneal epithelial
cells can be easily seen after fluorescein staining and using
the cobalt blue filter.
- Delayed epithelialization may occur in graft
with an extensive epithelial defect and eyes with compromised
healing ability i.e. post-chemical or radiation injury, Stevens-Johnson
syndrome, ocular pemphigoid, rosacea keratitis, or chronic blepharitis
with meibomian gland dysfunction.
- Nonhealing epithelial defect may be complicated
by corneal melting, thinning, perforation, infection or graft
rejection.
- Management:
- Routine follow-up with fluorescein to evaluate the corneal
after corneal transplantation surgery is important because epithelial
integrity is vital for graft survival.
- Treatment of pre-existing eye conditions pre-operatively i.e.
punctal occlusion in eyes with pre-existing dry-eyes.
- Meticulous protection and handling of the corneal button epithelium
during surgery to minimize epithelial loss / damage.
- Bandage soft contact lens or a lateral tarsoraphy may be helpful
in eyes with chronic non-healing defects.
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