Corneal epithelial erosion

Introduction Corneal epithelial erosion is a clinical condition caused by recurrent corneal erosion. Repeated corneal erosion occurs after the corneal epithelial damage (corneal rupture), and the re-epithelial adhesion to the basement membrane and the Babbitt layer is not tight enough, which may cause the eye to open once the eye is closed. The incompletely damaged cornea is torn apart again, and the symptoms of corneal rupture (eye tingling, redness, fear of light, tearing, squinting, etc.) are repeated again and again, and bacteria are also available. The machine causes infection and ulceration of the cornea. In addition, some people do not have a history of trauma, but there are symptoms of recurrent corneal erosion, which may be due to the presence of lesions in the basement membrane of the corneal epithelium, and further clarification of the cause. Superficial punctate keratopathy is a general term for three types of lesions of the corneal epithelium: punctate epithelial keratitis, punctate epithelial erosions, and punctate subcutaneous infiltration (punctate). Subepithalial infiltrates), they often exist at the same time, but the weight and extent of the lesion are biased and different.

Cause

1. Bacterial infection: in various bacterial conjunctivitis or blepharitis, often combined with epithelial erosion of the cornea and punctate superficial inflammation and subepithelial infiltration of the multi-membrane edge, these lesions are sometimes scattered on the cornea, sometimes Diffuse distribution on the whole cornea, especially in the peripheral part of the cornea.

2. Infectious infection: In the early stages of various viral conjunctivitis, it may often cause corneal punctate epithelial erosion.

3. Frequent eye irritation or UV stimulation can cause corneal epithelial erosion and inflammation.

4. Mechanical stimulation can cause epithelial abrasion, trichiasis and malnutrition can lead to epithelial erosion and inflammation.

5. Other eye diseases, such as dry keratitis, spring conjunctivitis, and drug allergy can cause damage to the corneal epithelium.

an examination

Related inspection

Fecal chymotrypsin blood test corneal examination

(a) Conscious symptoms

Photophobia, tingling, sour grinding, blurred vision or fog.

(two) signs

1, punctate epithelial keratitis: according to its different causes and signs vary.

(1) simple catarrhal keratitis: more common in the elderly. A needle-like gray-white infiltration along the limbus, or a pale yellow bead-like infiltration, can further develop a crescent-shaped shallow ulcer with parallel limbus.

(2) viral punctate keratitis: due to viral infection of the corneal epithelial layer or subcutaneous epithelial opacity infiltration, adenovirus is more common, such as adenovirus type 8 caused by epidemic keratoconjunctivitis, epidemic bleeding caused by enterovirus Conjunctivitis often causes monocular or binocular involvement. The bulbar conjunctiva is mixed hyperemia and mild edema. After 1 to 2 weeks, after the conjunctivitis subsides, it can cause inflammation and infiltration in the corneal epithelium and epithelium in the pupil area, and the dots are small gray dots or The punctate star-shaped line is turbid, and the fluorescein dyeing can be colored. After 2 to 3 days, these point-like infiltrates become flat, and soon become dendritic or map-like infiltration and merge into a mass.

(3) Surface punctate keratitis: manifested as inflammation of the corneal epithelial tip of both eyes, but no epithelial infiltration, which is light and heavy, and can last for several months. Under the high-fissure microscopy microscope, the point-like coloration was oval, slightly higher than the epithelial surface, and the keratitis did not leave scar after healing.

2, the following infiltration on the dot

(1) Trachomatous subepithelial invasive keratitis: at the end of the trachoma vasospasm above the cornea, there is a thick, superficial stromal ulcer, which often leaves thin or plaque after healing.

(2) money keratitis: in the epithelium of the corneal pupil area, such as coin-like infiltration, the size varies. Slit lamp examination, the infiltration is mostly in the superficial stromal layer, and often scars after healing.

3, punctate epithelial erosion

(1) Single or multiple punctate epithelial defects, the defect area is transparent, and the corneal epithelial edema around it is not easy to find under the direct sulcus, and the eye has repeated attacks, often with eyelids and ciliary congestion.

(2) In the early cases of superficial corneal dystrophy after traumatic or chemical debridement, periodic punctate epithelial erosion often occurs. After these defects are repaired, the epithelium often has fingerprints or vortex turbidity.

Differential diagnosis

Since superficial punctate keratitis is non-specific, it is identified from the primary disease according to the clinical. Shallow punctate keratitis is non-specific and is common in the following diseases: dry eye, blepharitis, exposed keratopathy, orbital skin relaxation syndrome. Shallow punctate keratitis is clinically common and has different characteristics.

The diagnostic basis is now split as follows:

1, staphylococcal keratitis: often associated with chronic conjunctivitis, concentrated in the lower third of the cornea. It is a point-like smashed skin with a fine point, ellipse or round infiltration of the epithelium.

2, red eye keratitis: mostly in the pupillary corneal epithelium or epithelial punctate infiltration, uneven size.

3, monosporous epithelial keratitis: epithelial point and linear infiltration quickly developed into a tree-like shape.

4, spring conjunctival inflammatory keratitis: mostly in the spring conjunctivitis, dotted line epithelial stripping on the entire cornea.

5, trachoma keratitis: epithelium and epithelial infiltration, erosion and shallow ulcer located at the upper end of the cornea, the end of the trachoma.

6, surface punctate keratitis: fluorescein staining in the corneal pupil area has a focus-like tip size fine dot on the table coloring.

7, drug-induced corneal dermatitis: evenly distributed on the entire surface of the cornea fine point turbidity, useful point of eye history.

8, radiation keratitis: more common in elated ophthalmitis, ciliary congestion, eyelids, tears and other symptoms, diffuse exfoliation of corneal epithelium in the cleft palate.

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