Anterior Basement Membrane Corneal Dystrophy

[MindfulMama]

My 54 yr. old maternal sister was just diagnosed with Anterior Basement Membrane Corneal Dystrophy (ABMCD) after going into the eye specialist for what appeared to be a painful, white, vertical scratch on her cornea. I suggested she get a second opinion, but she is on state medical and cannot afford to pay for a second opinion. Is a second opinion a good idea or is ABMCD an "easy" diagnosis? My sister has many medical issues. Is there any reasonable possibility it could be something else?

The specialist said that it is genetic and asked if she ever had a cold sore? She has not but I have had many. Is ABMCD mutation dominant or recessive? Should I make an appt. with an eye specialist to see if I have it?

She has another appt. in a couple of days. I'm going with her, but I want to have more knowledge before seeing the doctor so I know what questions to ask.

So, what exactly is ABMCD?
Causes?
What are the treatment options?
Medications?
Outcomes?

Thank you, Mindful Mama

[John C Hagan III, MD, FACS, FAAO]

Answered on a differnt post.

Yes-NO-your call on ?

JCH MD

[MindfulMama]

To: Dr. John C Hagan III, MD, FACS
by MindfulMama
  
Tags: Basement Membrane Dystrophy

Sorry for duplicate posting. I'm new to this.

Good to know Corneal Dystrophy/Basement Membrane Dystrophy (BMD) is not hereditary. I just found out that the eye MD also told my sister to look up maps-dots-fingerprinting (MDF) on the internet if she wanted more info. I'm confused, is BMD)and MDF the same thing?
Also, are either related to herpes simplex?

What questions should I ask the eye MD on next visit.

Thank you for your help.

[John C Hagan III, MD, FACS, FAAO]

BMD is relatively easy to diagnosis. It is not hereditary. It is common. The cause is unknown. It causes "recurrent corneal erosions" This is from a recent post on the condition:

You have "recurrent corneal erosion syndrome". The condition is common and will not destroy your sight or cause serious loss of vision. It has been discussed in the past in the eye care forums. It usually starts after a scratched cornea that does not heal properly. In some instances it occurs due to a common disease of the outer layer of the cornea (basement membrane disorder). Use the search feature and type in "corneal erosions".

Here is part of a recent post on the problem:

Recurrent corneal erosions are the bane of the practice of ophthalmology for both the ophthalmologist (Eye MD) and the poor patient. I saw 2 of them in the office today. They can be very difficult and recalcitrant to treat. Not infrequently they are controlled with drops and ointments but reoccur if these medications are stopped. I'm sure you're well versed on the medical and preventive treatment of corneal erosions.

Treatment is to avoid anything that dries the eye. So keep it moist with artificial tears. At bedtime a lubricating drop with normal saline (Muro 128 ointment---available over the counter) is put in the eye.  Extreme care must be used in the morning on awakening as this is when the tissue usually tears. Avoid rubbing the eye. If the eye wants to stay shut from the ointment leave it shut, splash with warm water till it opens then put in an artificial tear or Muro 128 DROPS (available as 2% or 5% [which often stings] also available over the counter. If Muro 128 products are irritation try Refresh-PM ointment at bedtime and a good artificial tear on awakening and several times during the day (Systane, Opteve, Soothe, Refresh, Tears Naturale, etc).

Long plane and car trips are very stressing for corneal erosions. In the car, run the air conditioner or heater on the feet vents not into the face. Put artificial tears in the eye every couple of hours on a car trip and every hour on a plane trip.

You should go a minimum of 4 months without any pain from the erosion (usually during sleep or upon wakening) before trying to stop the ointment. Be aware that some people are never able to stop the medications and must use drops, ointments and precautions indefinitely (years and years).

The next step is often corneal stromal micro-punctures. This is an office procedure done with just eye drop anesthesia; a bandage contact lens is put in the eye for several days. You may return to normal physical activities immediately.  

If the problem persists then you may need to discuss these treatments with your ophthalmologist. He/she should be able to do the first method. The second he/she may or may not be able to do, sometimes referral to a cornea specialist is indicated.

1. There is a new method of treatment when all else fails. It involves taking oral tetracycline for a couple of weeks coupled with steroid eye drops. If your ophthalmologist is not familiar with the method he/she can do a literature search of the medical ophthalmology journals. The first time I read of it was in the journal "Ophthalmology". I have used this method on two patients that were "at their wits end and had tried everything else. In both cases it worked. I still have them use an ointment at bedtime such as Muro 128 or Genteal Gel but the severe pain has stopped.

2. The last technique would be to use the eximer laser to "resurface" the corneal epithelium and soft contact lens wear during the healing. This technique is most often used when the cornea has disease that keeps causing the erosions, the most common of these is corneal epithelial basement membrane disorder.

Keep trying and good luck.

JCH MD