Nursing Beyond the Vital SignsNursing Beyond the Vital Signs

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Nursing Beyond the Vital Signs

Nursing is so much more than simply popping a thermometer in a patient's mouth or recording a blood pressure. In my time as a nurse, I have participated in life saving efforts when time was critical, I have held a mother's hands when her newborn baby was being prepped for surgery, and I have looked into the terrified eyes of an elderly person in pain. Nurses literally go into battle, serving in military operations all over the world. They also learn and implement the latest in medical technology. This blog is to highlight nurses and prove that they deserve respect and appreciation for all that they do.

Why Waking Up May Be A Pain In The Eye

For many, waking up in the morning and emerging from the comfort of a cozy bed is hard to do. For those with a particular type of corneal dystrophy, waking up to the light of day can be downright painful from the instant that they open their eyes. If you are one of these individuals, understanding this common condition and the treatment options available will offer welcomed relief of your symptoms.

Many Names, One Condition

Corneal dystrophy is a collective term for a group of more than 20 ocular conditions in which the cornea presents with structural irregularities. If your optometrist or ophthalmologist has issued a diagnosis of one of these conditions in particular, he may refer to it by any of the following names:

  • Epithelial basement membrane dystrophy (EBMD)
  • Map-dot-fingerprint dystrophy
  • Corneal microcystic dystrophy
  • Cogan corneal dystrophy
  • Anterior basement membrane corneal dystrophy

All of these names indicate the same specific disease process in which the outermost membrane of the cornea, called the epithelium, develops structural abnormalities. When examined by an optometrist, these abnormalities resemble dots, fingerprints or maps. One of the layers of the epithelium is called the basement membrane. When the surface of the epithelium undergoes these abnormal changes, the epithelial cells can no longer adhere correctly to the basement membrane. Erosion of the epithelium can then result, ultimately causing an alteration in the curved outline of the cornea.

Symptoms of EBMD

EBMD is typically diagnosed in individuals after the age of 40. Symptoms usually do not present until epithelial erosion occurs. The signs and symptoms of EBMD include:

  • Pain in the affected eye, especially when you first open your eyes upon awakening
  • Sensitivity to light
  • Excessive tearing
  • Sensations of having sand or a foreign body in the affected eye
  • Fluctuations in visual acuity

The pain of EBMD flares up when epithelial erosions occur to the point that the nerve endings are exposed. This pain is what prompts patients to seek a diagnosis and treatment. Until such erosion occurs, patients may not even be aware that they have EBMD.

How Is EBMD Treated?

EBMD is not a progressive disease that results in loss of vision. Recurring erosion flare-ups are typically treated with the goal of relieving your symptoms. This may be accomplished with the following treatment options:

  • Application of a sodium chloride hypertonicity ophthalmic ointment
  • Placing a patch over the eye to minimize its movement
  • Corticosteroid medications
  • Oral doxycycline antibiotic therapy

With the abovementioned treatments, erosions heal within days. Artificial tears can be helpful in preventing further irritation.

What If the Erosions Occur Repeatedly?

If you experience frequent recurrences of epithelial erosion, your ophthalmologist may discuss the following procedures to reduce these recurrences in the future:

  • Superficial keratectomy, in which the damaged cells of the cornea are manually scraped away to smooth out the damaged areas of the cornea
  • Phototherapeutic keratectomy, in which an excimer laser is used to eliminate damaged surfaces of the cornea
  • Anterior corneal puncturing, which results in a surface that facilitates improved adherence of epithelial cells

These are all minor surgical procedures that may be performed on an outpatient basis and do not require general anesthesia.

EBMD is a common condition, and approximately one-third of patients with EBMD experience recurrent erosion flare-ups. If you dreaded opening your eyes this morning, schedule an appointment with your optometrist or ophthalmologist for an evaluation and pain relieving treatment. Visit for more information on optical needs.