What Are Epithelial Basement Membrane Dystrophy & Recurrent Corneal Erosions? | Healthy Aging Month

Although it is not as common as some eye conditions like cataracts or glaucoma, epithelial basement membrane dystrophy is a serious eye condition that can lead to problems with the eye, including discomfort and distorted vision.

​The good news is that the condition, which affects the cornea, can be detected through a comprehensive eye exam.
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What Is Epithelial Basement Membrane Dystrophy?

Epithelial basement membrane dystrophy is not a familiar condition for most people. However, it’s important to know about, as it can lead to significant eye discomfort, pain, and vision impairment. When viewed during a slit-lamp exam, the corneal cells have the appearance of a map, dot, or fingerprint, which is why the condition is sometimes referred to as map-dot-fingerprint dystrophy.
 
It’s helpful to learn a little more about the cornea to understand epithelial basement membrane dystrophy. The cornea, the transparent layer forming the front of the eye, is made up of layers. The surface or outer most layer of the cornea is covered with a thin tissue called the epithelium. The cells of the epithelium attach to the underlying layers by the basement membrane.
 
In epithelial basement membrane dystrophy, the basement membrane becomes abnormal, which causes an increase in thickness. Due to the abnormal development, the surface layer does not adhere or stick well to the underlying layers of the cornea.
 
Why abnormal development of the cells occurs is not fully known. According to the American Academy of Ophthalmology, the condition may be inherited. However, in other instances, there is no genetic connection. It does appear to be much more common as we age, occurring mostly in people over the age of 40.
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Symptoms & Complications of Epithelial Basement Membrane Dystrophy

In many cases, there are no symptoms with epithelial basement membrane dystrophy. You may not even be aware that you have the condition until you’re diagnosed through a comprehensive eye exam, including a slit-lamp exam. A silt-lamp exam is the conducted as part of a regular eye exam. It involves using high-intensity light to look around and in the eyes.
 
When symptoms do occur, it is usually due to erosion of the cornea. Because the membrane layer is abnormal, the bond between cells is weakened, and the cells of the epithelial layer do not stick to the underlying membrane layer. This leads to corneal erosion. The erosion may feel similar to a corneal scratch, which can be quite painful.
 
Corneal erosions tend to happen overnight, when the eyes are closed. When people with epithelial basement membrane dystrophy wake in the morning and open their eyes, they may have experience pain. Additional symptoms of epithelial basement membrane dystrophy and corneal erosion include:

• Mild to moderate blurry vision
• Sensitivity to light
• Dry eyes
• Feeling like something is in the eye

• Watery eyes, especially in the morning

 
Epithelial basement membrane dystrophy does not usually lead to vision loss. But corneal erosions can be recurrent and very uncomfortable. The frequency can also vary greatly. For example, flare-ups may occur once or twice a year, or symptoms can occur a few times a week or even nightly.
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Treatment of Epithelial Basement Membrane Dystrophy

If you have epithelial basement membrane dystrophy and do not have symptoms, you usually don’t need treatment. If symptoms are present and you have corneal erosions, treatment is recommended. Treatment may include the following:
 
Eye Ointment
Your eye doctor may prescribe lubricating eye ointment to be used at night before going to bed. The ointment may help keep the eyes moist and prevent discomfort.
 
Artificial Tears
Using artificial years a few times throughout the day may help prevent dryness and decrease corneal erosions.
 
Phototherapeutic Keratectomy
If ointments and eye drops don’t improve the condition and corneal erosions are occurring often, phototherapeutic keratectomy may be recommended. The procedure involves using a laser on the basement membrane to make the surface rougher. The rough surface may allow the cells to stick together better and decrease corneal erosions.  
 
Surgery
If all other treatment does not work, and symptoms are severe, surgery may be an option. One procedure that may be performed is an anterior stromal puncture. The procedure involves using a needle to make tiny scars at the base of the epithelium. The scars help the epithelium adhere to the underlying corneal layers.
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Prevention of Epithelial Basement Membrane Dystrophy

There does not appear to be any way to prevent the development of epithelial basement membrane dystrophy. Once a diagnosis has been made though, there may be a couple of ways to decrease the chances of flare-ups and recurrent corneal erosions.
 
According to the AAO, keeping your environment moist by using a humidifier may be helpful. Using artificial tears consistently throughout the day, especially during the drier winter months, may also be useful.
 
Since the only way epithelial basement membrane dystrophy can be diagnosed is through a comprehensive eye exam, it’s essential to see your eye doctor regularly.  
 
If you have any questions about epithelial basement membrane dystrophy or corneal erosions or if you are concerned about eye discomfort / pain or other signs of eye problems, we are here to help. Please call our office at 508-746-8600 to schedule an appointment with one of our eye doctors.
 
Please check back with us soon for our last healthy aging post this month, as we cover “Cholesterol & The Eyes”. Thanks for reading!