Etiology: This disorder follows initial trauma to the surface cornea, such as the fingernail of a child carried in the parent's arms, a spiked-leaf palm tree, or a branch that snaps back on to the eye. Properly treated, this epithelial defect usually heals within a short time, i.e., 24 to 48 hours depending on the size of the defect. However, occasionally the epithelial cells do not properly adhere to Bowman's layer so that the epithelium repeatedly ruptures at the site of the initial injury. This characteristically occurs in the morning when the patient wakes up and suddenly opens his or her eyes. This recurring erosion often creates severe emotional stress for the patient.
Symptoms and diagnostic considerations: Immediately after the injury, the patient experiences a severe foreign-body sensation associated with tearing. Because there is actually a defect in the surface of the cornea, the patient has the subjective sensation of a foreign body within the eye. The epithelial defect causes severe pain, which immediately elicits a blepharospasm. Additional symptoms associated with corneal erosion include immediate eyelid swelling and conjunctival injection. Fluorescein sodium dye will readily reveal the corneal defect when the eye is examined through a blue light (Fig. 18.5).
Treatment: An antibiotic ointment eye bandage is used.
Treatment of recurrent corneal erosion often requires hospitalization. Bilateral bandages are placed to ensure that the eyes are completely immobilized.
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