Epithelial basement membrane dystrophy

Epithelial Basement Membrane Dystrophy (EBMD), also known as Map-Dot-Fingerprint Dystrophy or Anterior Basement Membrane Dystrophy, is a common corneal dystrophy affecting the epithelium of the cornea. It is characterized by the development of abnormal basement membrane material, which can lead to visual disturbances and discomfort. EBMD is typically bilateral and asymmetric, affecting individuals in their middle age, although symptoms can appear at any age.

Etiology and Pathogenesis

The exact cause of EBMD is not fully understood, but it is believed to be related to a combination of genetic predisposition and environmental factors. The dystrophy is characterized by the production of abnormal collagen and other extracellular matrix components by corneal epithelial cells. This leads to the formation of irregularities in the basement membrane, which can disrupt the normal adhesion between the corneal epithelium and underlying stroma, resulting in recurrent corneal erosions and visual impairment.

Clinical Features

Patients with EBMD may be asymptomatic or present with a range of symptoms, including:

• Blurred vision
• Photophobia (sensitivity to light)
• Foreign body sensation
• Episodic pain, especially upon waking

The hallmark signs of EBMD observed upon slit-lamp examination include:

• Map-like patterns: Irregular, geographic outlines on the corneal surface
• Dot opacities: Small, greyish dots scattered across the cornea
• Fingerprint lines: Concentric, fine lines resembling fingerprints

Diagnosis

Diagnosis of EBMD is primarily based on clinical examination with a slit lamp. In some cases, advanced imaging techniques such as confocal microscopy may be used to assess the structure of the corneal epithelium and basement membrane in greater detail.

Treatment

Treatment of EBMD focuses on managing symptoms and preventing recurrent corneal erosions. Options include:

• Lubricating eye drops and ointments to alleviate dryness and discomfort
• Bandage contact lenses to protect the cornea and facilitate healing
• Anterior stromal puncture or phototherapeutic keratectomy (PTK) for recurrent corneal erosions resistant to conservative treatment

Prognosis

The prognosis for individuals with EBMD is generally good, with appropriate management. However, some patients may experience recurrent episodes of corneal erosion, which can affect their quality of life.

Prevention

There are no specific preventive measures for EBMD, but individuals with the condition should avoid activities that increase the risk of corneal trauma. Regular follow-up with an ophthalmologist is recommended to monitor the condition and manage any complications promptly.

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