sir,
We read with interest the paper by Ramamurthi et al1 on recurrent corneal erosions. The authors should be congratulated for such a comprehensive review of this common condition. However, we feel that the use of alcohol debridement of the epithelium as an alternative treatment method should have been included.
Alcohol debridement has been mentioned in the literature since 2000.2 Its use first gained popularity after it was used in LASEK. It was noted that alcohol debridement cleaved a smooth plane and was associated with faster visual rehabilitation and reduced postoperative haze.3 Dua et al4 started to use this technique for recurrent erosion after noticing that following alcohol debridement there was increased difficulty debriding the epithelium if repeat LASEK was required. In their study,4 on the use of alcohol debridement for recurrent erosions, 75% had complete resolution of symptoms after 1 month of treatment.
We ourselves have used alcohol debridement as a treatment method in York since 2003 with comparable success rates. The technique we use is similar to that described by Dua et al.4 We apply 20% alcohol in a corneal well for 60 s. The epithelium is then rinsed with balanced salt solution and the loose epithelium removed. We then insert a bandage contact lens for 1 week or until the epithelium is healed.
Mah, as quoted by Lipner,5 felt that alcohol debridement does not present a valid alternative for recurrent erosions, feeling that it is more complicated and that the results are the same as those with mechanical epithelial debridement or microstromal puncture. However, we disagree. While we acknowledge that it is not a suitable treatment option for all patients, for recurrent erosion caused by localised trauma, in the absence of a dystrophy, it is a cheap, successful and readily accessible treatment method. It should therefore be mentioned as a valid alternative in units who do not have easy access to PTK.
References
Ramamurthi S, Rahman MQ, Dutton GN . Pathogenesis, clinical features and management of recurrent corneal erosions. Eye 2006; 20 (6): 635–644.
Shah S, Browning AC, Dua HS . Alcohol delamination of the corneal epithelial basement membrane in the human eye for photorefractive keratectomy (ARVO abstract). Invest Ophthalmol Vis SCi 2000; 41 (4): S681 Abstract nr 3623.
Browning AC, Shah S, Dua HS . Alcohol debridement of the corneal epithelium in PRK and LASEK: an electron microscopic study. Inves Ophthalmol Vis Sci 2003; 44 (2): 510–513.
Dua HS, Lagnado R, Raj D . Alcohol delamination of the corneal epithelium: an alternative in the management of recurrent corneal erosions. Ophthalmology 2006; 113 (3): 404–411.
Lipner M . Using alcohol delamination to treat recurrent erosion. Eye World 2006; 11 (23): http://www.eyeworld.org/article.php?id=3228.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lyon, F., Ellingham, R. Alcohol debridement for recurrent corneal erosions. Eye 21, 439–440 (2007). https://doi.org/10.1038/sj.eye.6702606
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.eye.6702606