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The cornea is the clear front covering of the eye ball. Common corneal diseases we see in the office include corneal ulcers, often related to the use of contact lens wear or corneal abrasions that result from trauma to the eye.
Another common problem we see is spontaneous abrasions in patients with a pre-existing condition called epithelial basement membrane dystrophy (or sometimes called map-dot-fingerprint). These patients have an inherent weakness of the surface layer of the eye.
A corneal ulcer is an open sore on the surface of the cornea. The cornea has a large supply of nerves and therefore corneal ulcers and scratches are typically painful. An ulcer may produce significant local redness, a scratchy feeling, blurred vision, sensitivity to light and in severe cases, swelling of the eyelids and pain.
Causes and Treatment
Treatment of corneal ulcers typically requires antibiotic eyedrops or if it is believed to be a virus, antiviral drops for herpes simplex. In rare cases, corneal ulcers may even be due to a fungus. Corneal ulcers are often associated with extended wear contact lens use, severe dry eyes, or patients with other superficial injuries to their eyes or eyelids.
Corneal abrasions are commonly seen and usually occur from something hitting or blowing into the eye while working in the yard or at work, or from an inadvertent poke to the eye or from sports injuries. Corneal abrasions or erosions can occur spontaneously, typically in the middle of the night or first thing upon awakening in the morning. These spontaneous erosions are commonly associated with epithelial basement membrane disease.
Corneal abrasions are best diagnosed at the slit-lamp with fluorescein dye in the eye. During this exam, a topical anesthetic will be applied into the eye and typically the pain will be relieved almost instantaneously.
Treatment of small abrasions is typically with antibiotic eyedrops or ointment. A minor corneal abrasion will heal on its own in one to two days. For larger abrasions, an eye patch may be necessary or a “bandage” clear contact lens may be placed on the eye for comfort. The eye may be sensitive to light and require sunglasses. Sometimes, oral pain medications may be required.
Abrasions associated with epithelial basement membrane dystrophy are typically treated in a similar fashion, but can often take much longer to heal and can recur again in some patients. A bandage contact lens is often placed on these eyes for an extended period of time for comfort and improved healing.