http://www.facebook.com/revoptom http://www.twitter.com/revoptom
http://www.revoptom.com/content/c/20600/
VOLUME 2, NUMBER 19
SEPTEMBER 12, 2011

HOW CAN I EFFECTIVELY MANAGE PERSISTENT CORNEAL STAINING?
A patient with persistent corneal staining before (top) and after one month of treatment with Lotemax and FreshKote. Click here to view larger image.
Most persistent corneal staining is caused by ocular surface disease, such as keratoconjunctivitis sicca (KCS). And because KCS—for example—is a chronic disease, the associated corneal staining typically will persist chronically as well. So, what are some options you can pursue to resolve such corneal staining?

First, be sure that the staining you note is nothing more than diffuse superficial punctate epitheliopathy (SPE), because any focal or deep staining may be indicative of an early infectious process.

If the staining is indeed superficial in nature, consider the following regimen:
  • Lotemax (loteprednol etabonate 0.5%, Bausch + Lomb) q.i.d. for two weeks, followed by b.i.d. for two more weeks. This will help quiet inflammation secondary to KCS. Because loteprednol 0.5% is an ester steroid with an excellent safety profile, it is an advisable choice for a four-week dosing cycle.
  • FreshKote (Focus Laboratories) b.i.d. for one month. FreshKote demonstrates 65mm Hg of oncotic pressure, so it can remove microcystic edema and help restore the ocular surface. It also features a series of lubricants that appear to effectively combat more advanced ocular surface issues.
If only moderate improvement is noted after one month of treatment, you could add low-dose oral doxycycline or even essential fatty acids supplements/nutraceuticals. Additionally, longer-term medications, such as cyclosporine, could be initiated, or the patient could continue using FreshKote.

However, the aforementioned agents alone are not as effective in SPE management as the addition of a corticosteroid, For that reason, it is advisable to pulse-dose a corticosteroid if SPE returns.
http://www.revoptom.com/content/c/20600/

"Nothing is impossible, the word itself says 'I'm Possible.'"
—Audrey Hepburn

 
       
Review of Optometry® is published by the Professional Publications Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.

To subscribe to other JMI newsletters or to manage your subscription, click here.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add revoptom@lists.jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Review of Optometry.