Basement Membrane Dystrophy

What is this condition--causes, treatment, prognosis?  I have had superficial keratectomy on one eye and could see more clearly a few days after the surgery.  However, the clearness has decreased now and the doc says there are more irregularities on the cornea again.  I'm doing eye scrubs twice per day and using artificial tears (without preservatives) multiple times per day.  What else can be done?

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

BMD is a common disease of the outer layer of the cornea. opaque lines in the shape of "dots" "fingerprints" and "maps" develop and may interfer with vision, cause light sensitivity, make the eyes water and can cause Recurrent Corneal Erosion Syndrome. The opaques lines change over time like sand dunes.

Lid hygeine is not going to help BMD but may help blepharitis. The treatment of BMD is basically the same as recurrent erosion, I'm going to paste a recent response on RES.

JCH III MD

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.

[RosieDe]

Thank you for the info.  I go back to the cornea specialist Jan. 2, 08.  It helps to understand the basics.

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

You are welcome.

JCH III MD

[JGM621]

I have BMD and treat nightly with gel which does wonders.  For months it has been excellent.  Today I needed to wear my contacts, which I have not done in at least 3 months.  Within an hour my left eye was red and irritated and now my right is as well.  I added lubricating drops throughout the day but to no avail.  Will I no longer be able to wear my contacts?

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

Very few patients with BMD can wear contacts successfully.  If you are myopic you might consider superfical Lasik (PRK). That could cure both your BMD and your myopia. You might even be able to get insurance coverage if the primary indication for the PRK is the BMD. Worth a shot.

See a refractive surgeon Eye MD. Find one at www.aao.org

JCH IIIMD