Corneal wound healing

Corneal wound healing

Gerald E. Lowther. OD. PhD. co-editor CL Commentary EINEMANN Cornea1 Wound Healing As contact lens fitters, we all see patients every day with min...

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Gerald E. Lowther.

OD. PhD. co-editor

CL Commentary


Cornea1 Wound Healing As contact lens fitters, we all see patients every day with minor foreign body abrasions, peripheral cornea1 staining, stippling, and other epithelial damage. Very seldom doessuch superficial damageresult in any infection or permanent damagesuch asscarring. These superficial disruptions usually appearclinically healed within a matter of hours if the cause is removed. Obviously, the cornea1epithelium is a very dynamic tissuewith a great capacity to regenerate and heal. With deeper damage, where the basement membrane is damaged, there may be clinical problems of adhesion of the epithelium to the underlying tissue, resulting in painful recurrent erosions. With the increasein the number of refractive surgeries, we are all routinely seeing patients with more extensive cornea1 damagewith scarring and haze, which takes much longer to

“heal.” In some cases, total healing does not seem to occur becausecorneal staining may remain after years in the area of incisions with radial keratotomy surgery. The cornea1 shape may alsofluctuate throughout the normal day for years after the surgerybecauseof the weakeningof the structure. With photo refractive keratotomy, corneal haze is presentfor sometime after the surgeryand may not totally resolve. The refractive surgery revolution has increasedthe interest and research in comeal wound healing. More basic information is desired on the mechanismsand time courseof healing. We would like to acceleratethe rate of healing while minimizing the visually disabling scarring. We would like the cornea not only to heal quickly and clearly but also to be dimensionallystable. Advances are being made in the understanding of the basic biochemistry

ICLC, Vol. 22, May/June, 1995 0 Elsevier Science Inc. 1995 655 Avenue of the Americas, New York, NY 10010

of wound healing and ways to control it. The use of steroids to control the refractive outcome of the surgeryis being used. Clinically usablegrowth factors and other medications to control the healing are being developed. In order to understand these changes, to properly counsel our patients, and eventually usethe new developments, we must understand more of the basic biochemistry and mechanismsof healing. In this issue, Pierrette DayhawBarker hasprepared a seriesof two articles on cornea1wound healing. She has systematically described the processof cell migration and wound healing. She has distilled a lot of material and madethis complicated subject understandable. I hope this will help you start to have a better understanding of this processand develop a foundation for the clinical advances that will be occurring in this field.

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