eMedicine Specialties > Ophthalmology > Cornea

Dystrophy, Macular: Treatment & Medication

Author: Natalie Afshari, MD, MA, FACS, Associate Professor of Ophthalmology, Duke University Eye Center, Duke University Medical Center
Coauthor(s): William B Trattler, MD, Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute; William Lloyd Clark, MD, Consulting Staff, Palmetto Retina
Contributor Information and Disclosures

Updated: Jan 26, 2010

Treatment

Medical Care

  • When recurrent corneal erosions occur with macular dystrophy, they are treated like any other form of recurrent corneal erosion.
  • Under the care of an ophthalmologist, a bandage contact lens along with antibiotics can be prescribed. Alternatively, patching with an antibiotic ointment or frequent application of an antibiotic ointment can be used.
    • Once the acute episode of recurrent corneal erosion resolves, preventive treatment may include sodium chloride 5% drops (eg, Muro 128) or artificial tear lubricating drops during the day and sodium chloride 5% ointment (eg, Muro 128) or lubricating ointment at bedtime.
    • If recurrent corneal erosions occur despite medical therapy, then excimer laser phototherapeutic keratectomy (PTK) may be considered.
  • Sunglasses are often helpful for severe glare symptoms.

Surgical Care

  • Excessive corneal erosions or a mild visual decrease can be treated with excimer laser PTK, which works best when the opacities are superficial.3 The excimer laser removes superficial corneal opacities, smooths the corneal surface, and allows the epithelium to re-adhere more tightly.
  • If visual acuity drops and the opacities are deep, lamellar or full-thickness corneal transplantation can be performed. Although the success rate for corneal transplantation is high, macular dystrophy deposits can recur with time.

Medication

Medical therapy for recurrent corneal erosions includes hypertonic saline, which is thought to increase adherence of the epithelium to the underlying stroma. Lubrication may also help prevent corneal erosions.

Hypertonic saline

This agent dehydrates the epithelium, allowing it to better adhere to the underlying stroma.


Sodium chloride 5% (Muro 128, Adsorbonac, Afrin)

Used for temporary relief of corneal edema.

Adult

Solution: 1-2 gtt to affected eye(s) tid/qid
Ointment: Apply 0.25-0.5 inch to lower cul-de-sac hs

Pediatric

Administer as in adults

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

May cause temporary burning and irritation upon use; if pain, change in vision, continued redness or irritation of the eye(s) occurs, reevaluate therapy; if initial condition/problem worsens or persists, reevaluate therapy; do not use product if it changes color or becomes cloudy

Lubricating agent

Moistens the ocular surface and decreases the frequency of recurrent erosions.


Artificial tears (GenTeal, Refresh tears, TheraTears, Bion tears, Refresh Plus)

Contains equivalent of 0.9% NaCl and used to maintain ocular tonicity. Acts to stabilize and thicken precorneal tear film and prolong tear film breakup time, which occurs with dry eye states.

Adult

Solution: 1 gtt 4-8 times/d to affected eye(s) or as directed
Ointment: Apply 0.25-0.5 inch to lower cul-de-sac hs

Pediatric

Administer as in adults

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Hyperemia, photophobia, stickiness of eyelashes, and ocular discomfort or irritation may occur

More on Dystrophy, Macular

Overview: Dystrophy, Macular
Differential Diagnoses & Workup: Dystrophy, Macular
Treatment & Medication: Dystrophy, Macular
Follow-up: Dystrophy, Macular
Multimedia: Dystrophy, Macular
References
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References

  1. Kannabiran C. Genetics of corneal endothelial dystrophies. J Genet. Dec 2009;88(4):487-94. [Medline].

  2. Quantock AJ, Young RD, Akama TO. Structural and biochemical aspects of keratan sulphate in the cornea. Cell Mol Life Sci. Dec 27 2009;[Medline].

  3. Al-Swailem SA, Al-Rajhi AA, Wagoner MD. Penetrating keratoplasty for macular corneal dystrophy. Ophthalmology. Feb 2005;112(2):220-4. [Medline].

  4. Albert D, Jakobiec F. Principles and Practice of Ophthalmology. Vol 1. 1996:26-49.

  5. Edward DP, Yue BY, Sugar J, et al. Heterogeneity in macular corneal dystrophy. Arch Ophthalmol. Nov 1988;106(11):1579-83. [Medline].

  6. Hafner A, Langenbucher A, Seitz B. Long-term results of phototherapeutic keratectomy with 193-nm excimer laser for macular corneal dystrophy. Am J Ophthalmol. Sep 2005;140(3):392-6. [Medline].

  7. Klintworth GK, Meyer R, Dennis R, et al. Macular corneal dystrophy. Lack of keratan sulfate in serum and cornea. Ophthalmic Paediatr Genet. Dec 1986;7(3):139-43. [Medline].

  8. Krachmer J. Cornea. Vol 2. 1996.

  9. Wirtitsch MG, Ergun E, Hermann B. Ultrahigh resolution optical coherence tomography in macular dystrophy. Am J Ophthalmol. Dec 2005;140(6):976-983. [Medline].

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Further Reading

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Keywords

corneal dystrophy, corneal stroma, anterior corneal dystrophy, stromal corneal dystrophy, posterior corneal dystrophy, corneal dystrophies

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Contributor Information and Disclosures

Author

Natalie Afshari, MD, MA, FACS, Associate Professor of Ophthalmology, Duke University Eye Center, Duke University Medical Center
Natalie Afshari, MD, MA, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

William B Trattler, MD, Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute
William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

William Lloyd Clark, MD, Consulting Staff, Palmetto Retina
William Lloyd Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma  Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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