How do you approach the decision to escalate from conservative medical therapy to surgical intervention in a patient with EBMD-related recurrent corneal erosions who has not responded to several months of nighttime lubricating ointment?

In the case of recurrent erosion in the setting of EBMD, we first attempt to optimize the conditions for a pristine and smooth ocular surface. This includes non-preserved lubricants, hypertonic saline to avoid swelling and sloughing at night, and treatment of any dry eye and meibomian gland dysfunction. It is also important to rule out neurotrophic keratitis. If the recurrent erosion syndrome is recalcitrant to these conservative management techniques, we would then suggest the use of a therapeu...

For recurrent erosions with or without EBMD with two or more clear corneal erosion episodes a year, I usually recommend surgical interventions starting with SK and moving to PTK in case of recurrence. There are no studies recommending the number of erosions before going to surgery, but 2 seems a reasonable number to avoid the risks of infections and patients' discomfort with more recurrences.

A subtype of those patients presents with repeated micro erosions or symptoms related to loose epithelium...