THE NATURAL-HISTORY AND MANAGEMENT OF RECURRENT CORNEAL EROSION - A PROSPECTIVE RANDOMIZED TRIAL

One hundred and seventeen patients with a history of recurrent corneal erosion were recruited at initial hospital presentation. Seventy-five cases had a history of shallow corneal injury, 23 had eptithelial basement membrane dystrophy (EBMD), 8 had both and 11 had neither. Mean age at presentation was 38 years and follow-up ranged from 6 to 16 months (measn 10.6 months). Sixty-one patients presented with a first acute corneal erosion, 21 with a subsequent acute corneal erosion and 35 with chronic symptoms. Patients with EBMD or a trauma-related focal epithelial basement membrane abnormality were more likely to present with chronic recurrent symptoms than trauma-related cases with no abnormality on examination. Both EBMD and trauma-related cases typically recurred in the lower half of the cornBa, frequently in the midline (z = 7.3, p < 0.001), suggesting an intrinsic or acquired abnormality of the epithelial basement membrane at this site. Only four 82 acute episodes did not resolve by 5 days with simple patching, cycloplegia and topical anbibotic ointment. In the vast majorityf of patients presenting with an acute erosion, simple management measures only are required. Of 117 cases started on prophylactic ointment at night, further therapy due to prophylaxis failure was required in only 5. EBMD was a risk factor for failure (relative risk 10.77). There was no difference in eficacy between once daily prophylactic paraffin and hypertonic saline ointments (p = 0.17), suggesting they both have only a lubricant action.