Anterior basement membrane dystrophy, also known as map-dot-fingerprint or epithelial basement membrane dystrophy, is a condition that affects the anterior (or front) of the cornea. In this condition, the membrane that lies beneath the corneal epithelium doesn’t function properly and can cause recurrent corneal erosions to develop. This is like a spontaneous scratch of the ocular surface. In fact, the condition can be caused by minor trauma to the eye such as can occur with a fingernail injury to the eye. The epithelium is the outer layer of the cornea, like the bodies skin, but actually a mucous membrane.
Both anterior basement dystrophy and recurrent corneal erosions are not uncommon and usually treatable conditions without permanent vision degradation.
Anterior Basement Dystrophy
Anterior basement dystrophy can be caused by genetics or by trauma to the cornea causing an abrasion, such as a scratch or complications from LASIK or other ocular surgery. In both cases, the condition can be treated. It rarely leads to permanent vision loss.
The basement membrane functions as a stabilizing anchor under the epithelium, mucous membrane or skin of the eye. In this condition, sheets of basement membrane extend into the corneal epithelium, looking like ‘maps’. The epithelial cells migrate towards the anterior surface of the epithelium and get trapped by the extra sheets of basement membrane that are not stabilized. These form ‘dots’, or cysts and/or concentric lines that begin to resemble ‘fingerprints’ in the latter case. If these maps or fingerprints are located centrally on the cornea, thereby overlapping with the pupil, vision can be adversely affected.
Many patients suffering from anterior basement dystrophy don’t display symptoms (90%), although some can have blurry vision, variable vision, or foreign body sensation associated with recurrent corneal erosions, if these occur. In addition to the discomfort, the eye may be red, watery and light sensitive. One of the largest risks associated with anterior basement dystrophy is scarring from recurrent corneal erosions.
Anterior basement dystrophy is diagnosed with a slit lamp test, as your eye doctor can see the cornea and effects of the condition, usually with the aid of a fluorescein dye. The prognosis differs from person to person – the disease progresses with age, but symptoms can get worse over time. In the event of a recurrent corneal erosion, the symptoms often begin in the middle of the night or upon waking.
Recurrent Corneal Erosion
When the basement membrane doesn’t stabilize the epithelium properly, recurrent corneal erosions can occur. This describes when spontaneous scratches, or breaks in the epithelium develop on the cornea. Relatively minor trauma, such as simply opening the eyes upon waking – the lid crosses the dry cornea and disrupts the epithelium, causing a scratch or break in the epithelium to occur.
Recurrent corneal erosions often cause mild to severe eye pain, lacrimation (tearing), photophobia (light sensitivity), and sometimes scarring leading to permanent vision loss. Erosions can last from just a few minutes to a few days, depending on the size of the abrasion.
Anterior Basement Dystrophy & Recurrent Corneal Erosion Treatment
If there is a history of recurrent corneal erosions, they may be prevented with night-time lubrication, saline ointments, or in some recalcitrant cases, surgical treatment.
Any treatment options for anterior basement dystrophy are to reduce the symptoms, such as improving any blurry or varied vision caused by the condition and prevent or reduce recurrent corneal erosion. There are a variety of treatment options available, such as lubricating ointments, antibiotic ointments or salt based ointments/drops. Symptomatic erosions can also be treated with a (bandage) contact lens or patching to shield the epithelium and exposed corneal nerves from the wiping action of the overlying eyelids.
Surgical options are also available as recurrent corneal erosion treatment in more severe cases. The surgical options are known as epithelial debridement and stromal puncture and are performed by an ophthalmologist.
Ensure you are scheduling regular appointments with your eye doctor to diagnose this condition and treat its debilitating symptoms. If you’re experiencing severe eye pain regularly, like when waking up, you may be suffering from recurrent corneal erosions or anterior basement dystrophy.
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