Recurrent corneal erosion medical therapy: Difference between revisions
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These all essentially try to allow the surface epithelium to reestablish with normal binding to the underlying [[basement membrane]], the method chosen depends upon the location & size of the erosion. | These all essentially try to allow the surface epithelium to reestablish with normal binding to the underlying [[basement membrane]], the method chosen depends upon the location & size of the erosion. | ||
The use of contact lenses may help prevent the abrasion during blinking lifting off the surface layer and uses thin lenses that are gas permeable to minimise reduced oxygenation. However they need to be used for between 8-26 weeks and such persistent use both incurs frequent follow-up visits and may increase the risk of infections. | The use of contact lenses may help prevent the abrasion during blinking lifting off the surface layer and uses thin lenses that are gas permeable to minimise reduced oxygenation. However they need to be used for between 8-26 weeks and such persistent use both incurs frequent follow-up visits and may increase the risk of infections. | ||
Patients with recalcitrant recurrent corneal erosions often show increased levels of [[matrix metalloproteinase]] (MMP) [[enzymes]].<!-- | Patients with recalcitrant recurrent corneal erosions often show increased levels of [[matrix metalloproteinase]] (MMP) [[enzymes]].<!-- | ||
--><ref>{{cite journal | author = Ramamurthi S, Rahman M, Dutton G, Ramaesh K | title = Pathogenesis, clinical features and management of recurrent corneal erosions. | journal = Eye | volume = 20 | issue = 6 | pages = 635-44 | year = 2006 | id = PMID 16021185}}</ref> | --><ref>{{cite journal | author = Ramamurthi S, Rahman M, Dutton G, Ramaesh K | title = Pathogenesis, clinical features and management of recurrent corneal erosions. | journal = Eye | volume = 20 | issue = 6 | pages = 635-44 | year = 2006 | id = PMID 16021185}}</ref> | ||
Revision as of 16:03, 31 December 2012
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Recurrent Corneal Erosion Microchapters |
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Differentiating Recurrent Corneal Erosion from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Medical Therapy
With the eye generally profusely watering, the type of tears being produced have little adhesive property. Water or saline eye drops tend therefore to be ineffective. Rather a 'better quality' of tear is required with higher 'wetting ability' (ie greater amount of glycoproteins) and so artificial tears (egviscotears) are applied frequently. Whilst individual episodes may settle within a few hours or days, additional episodes (as the name suggests) will recur at intervals. Where episodes frequently occur, or there is an underlying disorder, different types of curative procedures may be attempted:[1] use of therapeutic contact lens, controlled puncturing of the surface layer of the eye (Anterior Stromal Puncture) and laser phototherapeutic keratectomy (PTK).[2] These all essentially try to allow the surface epithelium to reestablish with normal binding to the underlying basement membrane, the method chosen depends upon the location & size of the erosion.
The use of contact lenses may help prevent the abrasion during blinking lifting off the surface layer and uses thin lenses that are gas permeable to minimise reduced oxygenation. However they need to be used for between 8-26 weeks and such persistent use both incurs frequent follow-up visits and may increase the risk of infections.
Patients with recalcitrant recurrent corneal erosions often show increased levels of matrix metalloproteinase (MMP) enzymes.[3] These enzymes dissolve the basement membrane and fibrils of the hemidesmosomes, which can lead to the separation of the epithelial layer. Treatment with oral tetracycline antibiotics (such as doxycycline or oxytetracycline) together with a topical corticosteroid (such asprednisolone), reduce MMP activity and may rapidly resolve and prevent further episodes in cases unresponsive to conventional therapies.[4][5]
References
- ↑ Liu C, Buckley R (1996). "The role of the therapeutic contact lens in the management of recurrent corneal erosions: a review of treatment strategies". CLAO J. 22 (1): 79–82. PMID 8835075.
- ↑ Indiana University Department of Ophthalmology - Phototherapeutic Keratectomy (PTK)
- ↑ Ramamurthi S, Rahman M, Dutton G, Ramaesh K (2006). "Pathogenesis, clinical features and management of recurrent corneal erosions". Eye. 20 (6): 635–44. PMID 16021185.
- ↑ Hope-Ross M, Chell P, Kervick G, McDonnell P, Jones H (1994). "Oral tetracycline in the treatment of recurrent corneal erosions". Eye. 8 (Pt 4): 384–8. PMID 7821456.
- ↑ Dursun D, Kim M, Solomon A, Pflugfelder S (2001). "Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids". Am J Ophthalmol. 132 (1): 8–13. PMID 11438047.