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Abstract
Although ulceration of the corneal stroma after alkali burns is known to be correlated with persistent epithelial defects, the relationship between a defect and the mediators thought to contribute to stromal destruction (plasminogen activator, plasmin, collagenase) has not been understood. This report demonstrates that fibrin and fibronectin appear on the stromal surface after an alkali burn, and that those substratum, matrix components disappear in correlation with the appearance of plasminogen activator on the stromal surface, re-surfacing by the epithelium and a persistent epithelial defect. The facts that epithelium releases plasminogen activator and that plasmin, generated from plasminogen by an activator, can degrade both fibrin and fibronectin, as well as the laminin component of the subepithelial basement membrane, would suggest that the plasminogen activator-plasmin system effect degradation of those macromolecules, thus initiating the events that lead to eventual, frank stromal ulceration. It is hypothesized that stromal ulceration is initiated by the chronic secretion from an epithelium with a persistent defect of a protease (plasminogen activator) involved in wound healing.