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Corneal Abrasion with Bandaid Contact Lens-How to Help Heal & avoid recurrence?
Hello again, This is re a corneal abrasion which just happened this week. I have been in the process of investigating options for IOL replacement for cataract surgery I had Feb 3. (See other post). Anyway...while being fitted for "try out" contact lenses 3 days ago by my opthalmologist's assistant for "redo" measurements for possible redo of my cataract/IOL surgery, I began to feel some discomfort and the assistant called the opthalmologist to the exam room. He told me that I now had a long scratch on my cornea over the pupil area. Naturally both I and he were horrified.  I did not feel the impact of the scratch as my eye was partyially anaethetized during the "contact lens try in"  The opthalmologist told me the scratch was about 6 ml long, right over the pupil, and he put a "bandaid contact lens" over the area.  I wasn't crazy about putting anything else in there after all that but he said I would be in quite a bit of pain when the anaethesia wore off and this would help it heal better. He also gave me antibiotic drops 3x day (Oflaxin) & to use systene eye drops often to keep it moist.  I saw him the following day and he said about half of it had healed but he wanted to keep the bandaid on. He exchanged the bandaid which was very uncomfortable and I went home. Returned the following day (yesterday) for the 2nd look-see and he said it was almost healed. In the process of checking the eye he again removed the bandaid which hurt quite a bit.) I was reluctant to put the bandaid back on after the pain of removing it twice, as now we were at the weekend, and he said it had healed enough to go without the bandaid if I was careful not to rub it.

I had quite of bit of watering and pain while wearing the bandaid and extreme light sensitivity the first 2 days, this is the third day, the bandaid is now off  and it is better. I just am praying it heals ok. I I'm still using the antiobiotic drops and refrequent systene drops. My vision yesterday got quite blurry and it is still blurry in this eye. The doctor told me this would pass but I don't know when. Altho I can use the computer off and on, especially with enlarged letters, I have to do it for much shorter periods of time and by evening my eyes have been pretty wiped out.  Of course in reading about this in the forums, I read about the much feared "recurrent corneal abrasian syndrome" and wonder if there is a way for me to prevent this since I am now in the healing process.  Also wonder when, generally speaking, this blurry vision goes away.

There's also the question that this is in the same eye where I had the cataract surgery on February 3.  I am wondering if this could affect my healing and also whether I have to hold off going to my 2nd opinion doc till the abrasion has healed as I'm assuming it would be hard to evaluate my options given this new turn of events.

Any insights highly appreciated!
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177275 tn?1511758844
Go to my (Dr. John Hagan MD) home page. There are about 31 posts on different problems. One is recurrent corneal erision treatment and prevention. You will need to us an ointment (like Muro 128) or lubricating gel (like systane gel or genteal gel) at bed time for 5-6 weeks and frequent artificial tears during the day. It take 6 weeks or more for the corneal abrasion to heal completely and not using something at bedtime and during the day can lead to recurrent erosion.
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Oh Thank You! For some reason I didn't get an email notification and just saw this answer. I am so appreciative. I will redouble on my moisturizing drops including night gels. I have the systene night ointment. Is Muro 128 preferred?

I do have two questions.  A few days ago I was given steroid drops to take twice a day because the swelling caused vision blurriness. My blurriness somewhat better but not gone yet.

1) Is there a point beyond which steroid drops can damage the eye?

2) As you may recall, I was in the process of investigating cataract options as this same eye (right) which got a long distance single length implant taking away my near vision. I'm a graphic artists. Would I be correct in assuming I need to wait till this is completely healed before pursuing my 2nd opinions on the right eye cataract surgery (or possible re-surgery?

Thank you and I'm heading toward your page!
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177275 tn?1511758844
Systane PM ointment is fine. Muro 128 has additional saline in it to draw fluid from beneath the erosion but what you are using is likely fine for a first abrasion. Many people we see have had erosions off an on for years and need the saline.

Steroid pills and drops have lots of side effects and the longer you are on them and the more you take the greater chance of problems. That is why steroids to the eye must be monitored by an Eye MD ophthalmologist.
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Thank you very much. I learned alot from your page re corneal abrasions. Appreciate your response and getting a general overview of this. I shall persevere in the current routine, The good news is that my vision though still blurry has improved the last couple days. Hopefully will be out of the woods soon but will continue to be careful!
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177275 tn?1511758844
best to you
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Update;  I am in a bit of a quandry as to next steps. My blurriness following the corneal abrasian I got March 31 is worse  & more cloudy the last two days after having gotten gradually better the 1st week. Haven't been able to go back to work I saw the ophthalmologist 4/8 and was concerned there was still a small not yet healed place on the cornea, After 10 days for a superficial scratch, I thought it would be all healed & just the edema to worry about? Still taking steroid drops (durazol 2x a day, oflaxin antiobiotic once a day & prolensa (an antiinflammatory) once a day. Concerned that  the healing process seems to have reversed, and concerns about  increased meds. Maybe fine but I'm  conservative when it comes to meds,esp steroids..  I have a 4/12 eye doc appt but after that he's on vacation. I think it would be a good idea to ask for a referral upwards. The question is to what type eye doc?I already have 2 existing appointments (4/20 with the retina doc as an existing patient for post-cataract surgery eval) (He doesn't know yet the details of all of this) and 5/2- new patient 2nd opinion cataract surgery appointment with a corneal specialist/surgeon. (Supposed to be excellent I've been waiting 2 months for the May 2 appt.) I realize the abrasion/blurriness may just heal on its own but I don't want to take any chances.  I have not had the back of my eye looked at yet. Am going thru my options and thinking I should probably see the retina doc sooner than 4/20, if I can get in...I will certainly not be lonely for eye docs next month, just these waiting periods are hard...
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Update;  I am in a bit of a quandry as to next steps. My blurriness following the corneal abrasion I got March 31 is worse  & more cloudy the last two days after having gotten gradually better the 1st week. Haven't been able to go back to work yet. I saw the ophthalmologist 4/8 and was concerned when told there was still a small not yet healed place on the cornea, After 10 days for a superficial scratch, I thought it would be all healed & just the edema to worry about? Still taking steroid drops (durazol 2x a day, oflaxin antiobiotic once a day & prolensa (an antiinflammatory) once a day. Concerned that  the healing process seems to have reversed, and concerned re  increased meds. May be fine but I'm  conservative when it comes to meds,esp steroids..  I have a  4/12 eye doc appt but after that he's on vacation. I think it would be a good idea to ask for a referral upwards. The question is to what type eye doc?I already have 2 existing appointments (4/20 with the retina doc as an existing patient for post-cataract surgery eval) (He doesn't know yet the details of all of this) and 5/2- new patient 2nd opinion cataract surgery appointment with a corneal specialist/surgeon. (Supposed to be excellent I've been waiting 2 months for the May 2 appt.) I realize the abrasion/blurriness may just heal on its own but I don't want to take any chances.  I have not had the back of my eye looked at yet. Am going thru my options and thinking I should probably see the retina doc sooner than 4/20, if I can get in...I will certainly not be lonely for eye docs next month, just these waiting periods are hard...
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177275 tn?1511758844
Your most pressing problem seems to be the cornea abrasion and so if you can get in to see a cornea specialist sooner that might be the better option.
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Thanx and sorry for length!
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177275 tn?1511758844
It's OK
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Thank You. Finger crossed, holding off on corneal consult as I think I am finally improving.. My doc will be on vacation soon and since the steroids, anti-inflam & antibiotics didn't get rid of the blurriness  he decided to try Muro128-overnite ointment. It was like a miracle, vision much improved the  next morning.  The only caveat is, eye is much more irritated, which it wasn't before. Obviously the improving vision is more important than the irritation, but wondering how long people take the Muro128. Just to get over the swelling? Or if there is a recurrence? If it is doing the job it would be nice to drop the steroids. I'll try to see doc before he leaves for vacation. It is a paradox though...if we should take all these hydrating drops during the day to lubricate, isn't Muro128 which gets rid of excess water\ in cornea, ,doing just the opposite?  
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177275 tn?1511758844
artificial tears lubricate the surface of the eye, Muro 128 dehydrates the interior of the cornea. It's sodium chloride (salt) saline and many eyes find it irritatiing and have to stop it other people I've had on it for years for recurrent erosions. If you are  unable to tolerate the ointment it comes in a 2% and %5 drop used during day.
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Thank you very much Dr Hagan for the thought of a lower strength. . I am delighted at the fast improvement after all those blurry days due to this med..  Didn't realize there was lower strength option.. Great to know. Am going to try the 5% one more night  due to the amazing improvement, almost like magic. Then if necessary switch to lower less irritating strength. Thank you again for putting up with all my questions Very grateful.. I hope my experience will help someone else.
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233488 tn?1310696703
Happy to help
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Kind of on the mend (I think) I hope you don't mind one more question. I just had a retina consult (post cataract surgery to check macular pucker)I I'd thought the retina doc could remark on the corneal edema healing but he didn't give me ay info , just that the macular pucker looked unchanged. He did not want to dilate my eyes or take eye pressure for fear of disturbing the corneal heating,  At this point i'm taking only muro128 5% ointment at nite & systene ultra no preservatives during day. I'm off the steroid drops for 4 days now. Since I didn't get the info I hoped from  retina doc I'm still wondering whether my symptoms are normal & will resolve.  Am now 3 weeks out. After some improvement I am again feeling more discomfort under my upper eyelids-twitching, the feeling of something being there,etc. Wondering if it has to do with scarring. Plus my vision is still decreased. My eye doc will be back in town in a week but I'd really like a 2nd pair of eyes to check this out. I do know one ophthalmologist (my 2nd opinion doc from 3/15) or an OD who may take a look at me.  What are questions I should ask if I am able to get in to see the doc in question? This new eyelid symptom is worrying me. Hope these aren't dumb questions.
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177275 tn?1511758844
As luck would have it I'm just back from having my eyes checked at a retina doctor's office.  Retina doctors tend not to comment much on anything other than the retina because they don't want to conflict with anything the referring ophthalmologist or optometrist is doing for the cornea, lens or other part of the eye. Since its flared up you might try and see your second opinion ophthalmologist until the other one is back from vacation.

You want to know if the cornea is swollen, if he/she can see an corneal erosion and have the Eye MD flip the upper lid to be sure nothing is under the list. remember the erosion/abrasion may look normal under the microscope but not be fully healed hence the need to continue Muro 128 at bedtime and drops during day for several months.
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Thank you so much Dr H  for that prompt answer.Funny you too got back from a retina doc. Hope it was good news. Sorry to be so late responding back. Yeah, not a fountain of cornea information there at the Retina Doc.! just read a letter from my eye doc to the retina doc last week. It advised him of the injury and suggested against doing the traditional "gonioscopy/CL". Another reason I'm sure for the retina doc's caution.

Tho I tried to get the 2nd opinion doc due to my irritated eye, she was out of town & no appt avail till Monday. I'm seeing the current eye doc Tues 4/26 anyway so will wait till then. And on 5/2 my appt is with a cornea specialist so worth waiting for. I'm glad to know about the slow (sometimes) cornea healing -good background info and keeps me sane!. I'll report back soon. (fingers crossed my vision will fully return and I can resume getting the cataract matter corrected). Thank you again for your responsiveness and excellent info.
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177275 tn?1511758844
Sure this is a common problem and while often painful and slow to heal rarely a cause of permanent vision loss
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Well that's reassuring. Thanks for the valuable info. I have been reading up on the whole condition since I'm seeing my returning Eye Doc tomorrow for the first time in 2 weeks.  I wonder if you might assist me with a few intelligent questions. I want to assess the status since I have had a work leave for 30 days due to inability to use our computer program there which has 8 pt letters (not enlargeable). I wish to return soon. My work has been considerably more difficult since the cataract surgery (which took away the near vision) but possible to do.

Here are my questions.
1) How does the doctor tell whether the epithelium is now full restored to the tissue below? Is there a test for this, or just the slit lamp?
2) How does he evaluate corneal edema?  Just from the vision tests, or are there objective findings where you measure the swelling?
3) How soon after all this may normal tests be resumed (eye pressure, gonioscopy, etc.
4) Re symptom of twitching & irritation of the involved eyelid, I take it this can also be evaluated in an office visit?

I see the 2nd opinion doc on May 2 for cataract re-surgery so want to make sure I'm not wasting his time but appearing too early.

Carolyn

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177275 tn?1511758844
1. If the eye is NOT healed it can frequently be seen easily with the slit lamp. However its possible for the cornea to look normal and there still be small corneal erosions that are too small to see.  It might be possible to see these with a cornea OCT but we do not have one of those in the office and I have no experience with that.
2. You can see the edema with the slit lamp.
3. It depends on how urgent those tests are. the more urgent the sooner the tests would be done. in an ideal work you might wait 6-8 weeks without any corneal symptoms before doing gonioscopy.
4. yes. twitching is often "myokymia" and is common and annoying but not usually serious
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Thank You so much, This information is so helpful to me in getting my questions ready! Best regards.
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177275 tn?1511758844
happy to help
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