Vol. 2, #15   •   Thursday, July 1, 2021


Review's Chief Clinical Editor
Paul M. Karpecki, OD, FAAO

Provides you with cutting-edge clinical strategies for optimal management of ocular surface disease and beyond.


Epithelial Basement Membrane Dystrophy

Another common differential diagnosis of dry eye disease is EBMD.

In addition to allergic conjunctivitis, another mimicker of dry eye disease (DED) is EBMD. Getting the right diagnosis for these two conditions is essential to successful management because the treatment strategies can be opposing. The treatment for EBMD is often to pull fluid (edema) from the eye via hyperosmotic agents, while the treatment for DED is to add fluid/lubrication via hypoosmotic agents like artificial tears, gels, or bland ointments.

What makes this a particularly difficult diagnosis is the more typical symptoms of EBMD (provided there is no recurrent corneal erosion) are foundational to DED (e.g., dry, gritty eyes and blurred vision)—meaning you have to rely on subtle symptom nuances and specific testing to determine it’s not dry eye. For example, expression and osmolarity should be normal (<300 mOSmol/L in both eyes), and you shouldn’t observe ocular surface NaFl staining. But what are the primary differentiating factors?

In the case of DED, symptoms of blurred vision are typically fluctuating (unless central SPK is noted), while symptoms of blurred vision from EBMD tend to be consistent.

As far as signs are concerned, a thorough slit lamp exam of the cornea should reveal map, dot, or fingerprint patterns. However, signs may be hard to detect even if symptoms are present. A good way to determine their presence in these circumstances is with NaFl dye. DED patients will experience a rapid tear film break-up time, but the location of the break-up should vary. In the case of EBMD, the breakup will consistently show up in the same place.

EBMD is a very important differential diagnosis and one of the most common causes of dry eye symptoms in patients with normal dry eye testing. Certainly, these two conditions can occur simultaneously, but determining their presence is important for successful patient care.

KEY TAKEAWAY: EBMD is a common mimicker of dry eye disease, as symptoms are often similar. Look for consistently blurred vision without dry eye signs, or a TBUT that consistently breaks up in the same place to be a possible EBMD presentation.

Supported by an independent medical grant from Kala Pharmaceuticals

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