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.