Epithelial basement membrane dystrophy

Epithelial basement membrane dystrophy (EBMD), is a disorder of the eye that can cause pain and dryness.

Epithelial basement membrane dystrophy
Other namesMap-dot-fingerprint dystrophy and Cogans's microcystic dystrophy
SpecialtyOphthalmology

It is sometimes included in the group of corneal dystrophies.[1] It diverges from the formal definition of corneal dystrophy since it is non-familial in most cases. It also has a fluctuating course, while for a typical corneal dystrophy the course is progressive. When it is considered part of this group, it is the most common type of corneal dystrophy.[2]

Signs and symptoms

Patients may complain of severe problems with dry eyes, or with visual obscurations.[3] It can also be asymptomatic, and only discovered because of subtle lines and marks seen during an eye exam.[2]

EBMD is a bilateral anterior corneal dystrophy characterized by grayish epithelial fingerprint lines, geographic map-like lines, and dots (or microcysts) on slit-lamp examination. Findings are variable and can change with time. While the disorder is usually asymptomatic, up to 10% of patients may have recurrent corneal erosions, usually beginning after age 30; conversely, 50% of patients presenting with idiopathic recurrent erosions have evidence of this dystrophy.[4]

Pathophysiology

In some families autosomal dominant inheritance and point mutations in the TGFBI gene encoding keratoepithelin have been identified,[5] but according to the International Committee for Classification of Corneal Diseases (IC3D)[6] the available data still does not merit a confident inclusion of EBMD in the group of corneal dystrophies. In view of this, the more accurate designation of the disease is possibly not dystrophy but corneal degeneration.[7]

The main pathological feature of the disease is thickened, multilaminar and disfigured basement membrane of corneal epithelium. The change in the structure affects the epithelium, some cells of which may become entrapped in the rugged membrane and fail to migrate to the surface where they should undergo desquamation.

Treatment

Phototherapeutic keratectomy (PTK) done by an ophthalmologist can restore and preserve useful visual function for a significant period of time in patients with anterior corneal dystrophies including EBMD.[4]if the erosion is not clearing with medication the ophthalmologist can prick it with a needle multiple times to try and stick it back down (no pain). Alternately, they will scrape all the skin left on your eyeball off so that it reforms from scratch.

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See also

References
  1. Online Mendelian Inheritance in Man, #121820: Corneal dystrophy, epithelial basement membrane; EBMD, archived from the original on 2017-04-30.
  2. Chan, Colin (2015-02-18). Dry Eye: A Practical Approach. Springer. pp. 111–112. ISBN 9783662441060.
  3. John R. Martinelli, O.D. (22 March 2010). "When Should You Treat EBMD with PTK?". Review of Optometry. Retrieved 16 March 2017.
  4. Online Mendelian Inheritance in Man (OMIM): 121820
  5. Boutboul S, Black GC, Moore JE, Sinton J, Menasche M, Munier FL, Laroche L, Abitbol M, Schorderet DF (June 2006). "A subset of patients with epithelial basement membrane corneal dystrophy have mutations in TGFBI/BIGH3". Hum. Mutat. 27 (6): 553–7. doi:10.1002/humu.20331. PMID 16652336.
  6. Weiss JS, Møller HU, Lisch W, Kinoshita S, Aldave AJ, Belin MW, Kivelä T, Busin M, Munier FL, Seitz B, Sutphin J, Bredrup C, Mannis MJ, Rapuano CJ, Van Rij G, Kim EK, Klintworth GK (December 2008). "The IC3D classification of the corneal dystrophies". Cornea. 27 (Suppl 2): S1–83. doi:10.1097/ICO.0b013e31817780fb. PMC 2866169. PMID 19337156.
  7. David Verdier (2019-02-14). "Map-dot-fingerprint Dystrophy". eMedicine. Cite journal requires |journal= (help)
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