Clinical Signs and Diagnosis
The ulcer itself may appear as a grey or white lesion on the cornea. Blood vessels may grow towards the ulcer from the outer aspect of the eye, resulting in red regions on the corneal surface. Fluorescein, anophthalmic marker, is used to diagnose a SCEED, typically in association with loose epithelial edges when viewed under a hand-held microscope.
Treatment of SCCEDs using medication alone can be challenging, as these ulcers are often resistant to conventional therapy. Many cases of SCCED benefit from surgical treatments including:
This involves creating a series of superficial incisions in the cornea using a surgical needle. The aim of this procedure is to promote epithelial cell migration and adhesion to the underlying stroma by providing ‘gripping points’. Grid keratotomy is typically performed under general anaesthesia using an operating microscope. The majority of the corneal surface usually benefits from treatment to reduce the risk of ulcer recurrence, and a bandage contact lens is placed on the eye postoperatively in many cases to protect the cornea.
Diamond Burr Debridement
This involves using a rotating ophthalmic grade diamond burr to remove the non-adherent epithelium and ‘freshen’ the underlying stroma to encourage the epithelium to fully attach and achieve healing. This procedure can be performed in some cases under local anaesthetic, if the area requiring treatment is accessible.
Following surgical treatment, antibiotic eye drops, corneal lubrication and some pain-relieving medications are typically prescribed until the ulcer has healed. This typically takes 7-10 days following surgical treatment.