Impaired adhesion, migration, and/or mitosis can compromise corneal
epithelial healing. Persistent epithelial defects can progress to ulceration,
perforation, or endophthalmitis. Currently, our options are limited to methods
that address the underlying cause of the epithelial defect. In addition to
addressing exposure keratopathy, mechanical irritation to the eye, and systemic
diseases, clinicians supplement the tear film, minimize the mechanical aspects
of delayed wound healing, and use collagenolytic enzyme inhibitors. Specific
therapy includes preservative-free artificial tears, pressure patching, bandage
contact lens, and N-acetylcysteine. The more recent
use of nerve growth factor,1 amniotic membrane
transplantation,2- 4
and scleral lens2 has been reported. Nonsurgical
therapeutic options have limited effect, and surgical procedures such as lamellar
or penetrating keratoplasty become necessary to preserve the anatomic integrity
of the globe. Vision-threatening procedures (Gunderson flap, tarsorrhaphy,
evisceration, or enucleation) may also become necessary.