Corneal Resurfacing Procedures
Salzmann's Nodular Degeneration:
Salzmann's nodules are elevated areas of scar tissue on the cornea. They can develop and worsen in the presence of dry eye (eyelid friction) and contact lens wear. Thus, before surgical treatment is undertaken, we will first work to treat ocular surface dryness and tear insufficiency. However, in many cases, these nodules can continue to cause discomfort and can interfere with the quality of vision, causing image distortion, increased astigmatism, and glare. Dr. Singh commonly removes Salzmann nodules and resurfaces the cornea in our office with a simple and relatively quick procedure. He removes the scarred and elevated tissue and cleans and smooths the cornea down to the epithelial basement membrane. He can then apply a few unique procedural steps to ensure maximum success with healing: he can texturize the basement membrane with a diamond burr to allow the new epithelial regrowth to adhere smoothly and successfully; he also applies a medicine to reduce inflammation, and covers the surface with an amniotic membrane graft beneath a bandage contact lens to provide the optimum environment for healthy, smooth epithelium to re-grow and adhere seamlessly. Bandage contact lenses are replaced and worn for several weeks so that blinking does not interfere with the treated surface. At the end, the cornea is topographically smooth and vision can be maximized.
Map Dot Fingerprint Dystrophy (MDFD) a.k.a Epithelial or Anterior Basement Membrane Dystrophy (EBMD/ABMD):
"MDFD" is a condition in which the corneal surface has topographical irregularities caused by redundancy and undulation of the corneal epithelial basement membrane. The lines and wrinkles can look like "map dots" or "fingerprints," hence the descriptive name. Like with Salzmann's nodules, this condition is often caused or exacerbated by dry eye, and treatment of dryness is often the first step of therapy. If needed, surgical treatment of this condition is also much like the treatment for Salzmann's: in the clinical office setting, Dr. Singh removes the imperfect epithelium and cleans and smooths the cornea down to the epithelial basement membrane. He can then texturize the basement membrane with a diamond burr to allow the new epithelial regrowth to adhere smoothly and successfully; he also applies a medicine to reduce inflammation, and covers the surface with an amniotic membrane graft beneath a bandage contact lens to provide the optimum environment for healthy, smooth epithelium to re-grow and adhere seamlessly. Bandage contact lenses are used for several weeks so that blinking does not interfere with the treated surface.
This procedure is also performed for patients who suffer from recurrent corneal erosions.
Recurrent Corneal Erosions:
A recurrent corneal erosion happens after a patient's cornea has been scratched open, (a corneal abrasion), often from an injury or sometimes from severe dryness. After a corneal abrasion, the corneal epithelium often does not heal perfectly smoothly and is susceptible to re-opening. Often these re-opening episodes are experienced first thing in the morning, after the eyelid becomes stuck to the damaged area of the cornea during sleep and then rips the scratched area back open upon awakening. (This is very painful!) Many patients with this condition are able to use ointment in the eye during sleep to prevent these re-openings, but some patients continue to suffer from symptoms of recurrent morning pain in the previously injured area. For these patients, a re-surfacing procedure, like that which is used for patients with MDFD seen above, can provide a renewed and perfectly smooth corneal epithelium that no longer erodes.
Diagnosing these corneal conditions can be very subtle, but effectively treating and managing corneal pathology can make a significant difference in ocular comfort and quality of vision. Contact us today to book a corneal evaluation with any of our doctors, and see if a corneal procedure can improve your quality of life.
Salzmann's Nodular Degeneration
Map-dot fingerprint on the cornea
Recurrent corneal erosion area on cornea