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R.S. Hedayi, J.C. Affeldt, M.R. Agarwal; Epithelial Basement Membrane Dystrophy and Dry Eye . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3757.
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Purpose: Classic discussions of epithelial basement membrane dystrophy (EBMD) present a condition which aside from recurrent erosion, clinically does no more than produce mild visual disturbance secondary to unstable overlying tear film. The purpose of this report was to describe a series of advanced EBMD patients with visual loss symptomatic enough to require corneal scraping, and to document for the first time their association with aqueous deficient dry eye. Methods: All patients underwent Humphrey Systems topographic analysis for surface corneal irregularity measurements (CIM), quantitated corneal sensation testing (Cochet-Bonnet aesthesiometer), aqueous tear secretion testing with topical anesthesia (Schirmer method), and finally manual corneal scraping under slit-lamp control. Results: Fourteen eyes of 12 patients were identified with advanced central EBMD producing highly symptomatic visual loss (mean VA = 20/100). Mean corneal irregularity measurements (CIM) demonstrated significantly elevated levels of irregular surface astigmatism as compared to controls (6.20 versus 0.74; P=0.001), while mean Schirmer values were significantly reduced as compared to controls (5.5 mm versus 16.3 mm; P=0.005). Mean central corneal sensation was likewise significantly depressed as compared to controls (39.3 mm versus 56.3 mm; P=0.04). Corneal scraping produced an average visual improvement of 3.5 lines. Conclusions: Advanced EBMD can produce marked loss of visual acuity secondary to irregular surface astigmatism. This condition is strongly associated with aqueous deficient dry eye, which may in turn result from underlying corneal hypoesthesia. Corneal scrapings can produce dramatic visual improvement, but prophylactic punctal occlusion should be considered to prevent hypoesthesia related corneal wound healing complications and possibly EBMD recurrence.
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