November 20, 2023

Epithelial apoptosis: An abrasion of the superficial layer of the cornea

What exactly is corneal epithelial apoptosis?

The term epithelial apoptosis refers to an abrasion of the surface layer of the cornea, which usually occurs after a minor injury to the eye, causing a portion of the epithelium to detach from the underlying membrane.

What are the main causes of epithelial apoptosis?

An epithelial apoptosis often results from:

  • Injury from a foreign body (e.g. paper, wood etc.)
  • Self-injury, usually after vigorous eye rubbing or clumsy handling of contact lenses
  • Rarely due to corneal dystrophy, i.e. poor epithelium construction

What are the main symptoms of epithelial apoptosis?

Some of the basic symptoms of this ocular condition are the following:

  • Tearing
  • Redness
  • Photosensitivity
  • Blurred or impaired vision
  • Foreign body sensation
  • Pain while blinking

How can we treat epithelial apoptosis?

An ophthalmologist will diagnose the presence and the degree of apoptosis’ severity by using a special dye called fluorescein, during thorough slit-lamp clinical examination.

The initial action, if needed, involves the removal of a foreign body. Minor injuries may not require treatment, as they typically resolve by their own within a few days. Extensive injuries may be treated with pressure bandages or temporary therapeutic contact lenses for about 24 hours, aiming at healing and preventing recurrence.

Recurrent epithelial apoptosis

The syndrome of recurrent corneal epithelial apoptosis is characterized by repeated episodes of acute symptoms (in one of the two eyes), caused by the loose of construction adhesion between the epithelium and the underlying corneal membrane.

While the corneal epithelium usually heals within a few days, this episode tends to recur at irregular intervals, ranging from a few days to months later.

For effective management of recurrences, interventional solutions include:

  • The superficial scraping of the corneal epithelium, a simple procedure where the loose or altered part of the epithelium is removed. After removal, a therapeutic contact lens is placed for approximately 4-5 days
  • Allusions of the anterior layer of the cornea with the aim of improving adhesion of loose epithelium in the underlying layer (in case of immediate relapse)
  • Modern laser treatment, specifically phototherapeutic keratectomy (PTK) with an excimer laser, aims to regenerate the epithelium and activate new strong connections between the epithelium and the underlying membrane of the cornea. This is a permanent treatment with a success rate exceeding 90%, preventing painful recurrences.

Dimitris Sakellaris MD

Ophthalmic Surgeon

Specialized in Cornea & Anterior Segment Surgery