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Causes
- usually after trauma (injury with fingernail, object)
- can also occur spontaneously, e.g. in map-dot fingerprint, recurrent erosions after previous trauma
Findings
- Epithelial defect, stains with fluorescein, no infiltrate
- Trauma: laceration/perforation? Anterior chamber cells?
- Evert the upper lid to rule out any subtarsal foreign body
Management
- Consider prophylactic antibiotic treatment
- e.g. Tobrex gtt (Tobramycin) 4x daily or Floxal gtt (Ofloxacin) 4x daily (alternatively ointment)
- in case of injury with organic material (branch, plant, fingernail etc.): Floxal gtt 4x daily
- consider additional lubrication (drops, vitamin A ointment at night)
- consider cycloplegic drops (e.g. Scopolamine 0.25% 1-3x daily)
- in case of large erosions: consider Floxal ointment and bandage or bandage contact lens + Floxal gtt 3x/d
- in case of loose epithelium: debridement with a hockey knife
Follow-up
- Depending on findings:
- small epithelial defects: further appointments may not be needed
- large epithelial defects: the next day: re-epithelialisation tendency? Then until epithelial closure
- Contact lens wearers should wait at least 7-10 days after epithelial closure to insert a new contact lens
Important Differential Diagnosis
- Herpes simplex Keratitis (Dendrites? Corneal sensation?)
- Neurotrophic Keratopathy
Recurrent Erosions
Sources
- EyeWiki Corneal Epithelial Defect
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilki; 7. Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8. Edition(2015)