Why the surface comes loose
The epithelium is anchored to the cornea by a basement membrane and fine attachment complexes that take months to re-form after an injury. If a fingernail scratch, a paper cut or a branch tears the epithelium, the regrown surface may attach weakly, and it may be abnormal from the start in epithelial basement membrane dystrophy. During sleep the surface dries slightly and the eyelid adheres to it; on opening, the lid pulls the weakly attached epithelium away, producing an erosion and the sudden pain that characterizes the condition.
Symptoms
Attacks range from a brief sharp pain on waking that eases within minutes, to a severe, watering, light-sensitive eye with blurred vision that takes days to settle. They recur at irregular intervals, often weeks or months apart, and typically in the same eye. Between attacks the eye may feel normal or slightly gritty.
Diagnosis
The history is usually diagnostic. At the slit lamp the specialist looks for the healed or healing erosion, for the map, dot and fingerprint patterns of basement membrane dystrophy in both eyes, and for loose epithelium that moves with a gentle touch. Dye highlights areas of poor adhesion. Examination soon after an attack is most informative.
Treatment, stepwise
- Acute attack: lubricants, a bandage contact lens if the erosion is large, antibiotic drops to protect the open surface, and pain relief until it heals in one to three days
- Prevention: a thick lubricating ointment at bedtime every night for several months, so the lid cannot adhere, and hypertonic saline drops or ointment to keep the surface firmly attached; most patients settle on this alone
- Persistent cases: an extended-wear bandage contact lens for several weeks to let attachments re-form; a short course of oral doxycycline and topical steroid, which reduce the enzymes that loosen the surface
- Surgical: epithelial debridement with polishing of the basement membrane, or anterior stromal micropuncture for erosions outside the visual axis, both quick office procedures
- Laser: phototherapeutic keratectomy (PTK), which removes the abnormal basement membrane with the excimer laser and gives the epithelium a fresh surface to bond to; the most reliable treatment for stubborn cases
Living with it
Erosions are frightening but not dangerous when treated, and most patients stop having them within a year of consistent nighttime treatment. Patients with basement membrane dystrophy who later want laser vision correction are steered to PRK rather than LASIK, which suits the condition and can itself resolve the erosions.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is what is affecting your vision is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
