Treatment of corneal erosions for child and adult is basically the same.

Once the blister has occurred, the main treatment is for the severe pain that can accompany the episode. Oral analgesics such as Paracetamol may well be of help, but if oral medication is difficult, a drop such as Voltarol Ophtha (Diclofenac sodium 0.1%) may be of benefit.

Quiet rest, with the eyes shut is also helpful, since the eyelids form a ‘bandage’ over the eye, and the reduced movement of the eye itself reduces further friction of the lids on the affected area.

Anaesthetic eye drops such as Benoxinate should not be used as a treatment, since they delay the healing process, and the anaesthetic effect increases the danger of further trauma without the patient realising it. Anaesthetic drops are used for examination of the eye, and in certain special cases, under the supervision of a clinician, can be used to help the patient carry out a specific task. For instance, if a nervous child/adult is due to go to theatre, and has a severe episode of corneal blistering, local anaesthetic drops may help them see, as they go down to theatre, since lack of vision may increase anxiety further. However, the anaesthetist and operating staff must be made aware that drops have been instilled.

Steroid eye drops should only be used under strict supervision from a hospital expert, since they can have adverse affects.

Instillation of lubricants at the acute stage is also beneficial. Gels and ointments such as Lacri-Lube or Simple Eye Ointment are preferable since their effect lasts longer than drops, and reduces the need for frequent re-application. However, if it is impossible to open the eye to instill the lubricants, then it is best to abandon the treatment, otherwise further trauma can occur from the action of trying to prise open the lids.

If after 24 hours the erosion has not improved and there is a suspicion of infection, an ointment containing an antibiotic such as Fucithalmic gel, or Chlorampenicol ointment can be added under the supervision of a clinician.

Padding the affected eye can help with symptoms such as pain, but does not necessarily shorten the healing time. Keeping the pad in place is a problem, since tape cannot be used. So, using Tubifast, Netelast, or conforming bandage is recommended, although regular checks that the pad is correctly in place is necessary, since the pad itself can cause friction and therefore further damage to the affected eye.

Wearing sunglasses during an episode of corneal erosion reduces the problem of photophobia (pain on looking at bright light). When the eye is damaged, the iris (coloured part) of the eye goes into spasm, and as a result when the patient is in bright sunlight/ brightly lit room, the pupil constricts causing further spasm of the iris and resultant pain. If this pain is severe, instillation of a dilating drop such as Mydrilate (Cyclopentolate hydrochloride 0.5%/1%), ‘relaxes’ the iris and reduces the pain.

It has been shown that prophylactic (preventative) treatment of the eyes of patients with EB, reduces the incidence of corneal erosions.

Routine application of lubricant gels or ointment every night whether there are eye problems or not, appears to reduce the incidence of erosions considerably. Lubricant drops for use during the day (ointments tend to cause transient blurring of the vision), as necessary, also appear to help.