Epithelial Basement Membrane Dystrophy (EBMD) Overview

Epithelial basement membrane dystrophy (EBMD), also known as anterior basement membrane disease or map-dot-fingerprint dystrophy, is a common condition that affects the cornea of the eye (the clear, dome-shaped structure in the front part of the eye that a contact lens is placed on).

The condition usually affects people over 30 years of age. EBMD is sometimes silent, leaving those affected unaware of their condition. Some people with the disease have subtle corneal irritation that is short-lived, while others may have chronic symptoms that seem to act up every day.

Understanding EBMD

EBMD is a disorder of the basal epithelial cells located in the front part of the cornea. These basal cells stick to the second membrane layer, also referred to as Bowman's layer. In EBMD, the basal cells create abnormal, finger-like projections that stick out from the thickened underlying membrane. These projections cause the epithelial cells to become loose. Along with other changes that occur among the epithelial cells, these changes give an appearance of maps, dots, and fingerprints within the cornea. These characteristic changes can be seen with the use of a slit-lamp biomicroscope.

Risk factors for progression or exacerbation of EBMD include trauma, such as corneal abrasion, as well as LASIK or other intraocular surgery. 

Symptoms

People with EBMD may complain of the following symptoms:

• Fluctuating vision
• Blurred vision
• Intermittent pain

Most people affected by EBMD have fluctuating vision without much discomfort. However, about 10% have painful episodes of recurrent corneal erosion. Recurrent corneal erosions are small defects in the surface of the cornea. These defects are spots of missing epithelial cells that fall off easily because of the disorder. The finger-like projections that form cause these cells to become loose, causing them to lose their adherence to the underlying membrane.

Symptoms tend to be worse during the morning hours, because the eye dries out at night, and the cells that are poorly adhered seem to come off more easily upon waking.

Diagnosis

EBMD is often missed by healthcare providers, since the corneal map, dot, and fingerprint appearance that commonly develops with this condition can be subtle in many cases. However, upon close inspection, these characteristic changes can be detected. Eye doctors will listen closely to your symptoms and overall medical history, which may provide clues. A special yellow dye may also be put into your eye to make subtle corneal surface changes more visible. Your healthcare provider may also perform keratometry or ​corneal topography, which measure the overall shape of the cornea. Your tear film will also be studied under the microscope to rule out other conditions, such as keratoconjunctivitis sicca and other subtle dry eye conditions.

Treatment

Treatment for EBMD is aimed at reducing the number of painful, symptomatic erosions. In people who don't have apparent symptoms, treatment includes using artificial tears several times per day to encourage optimal epithelial cell health. People with more noticeable symptoms will be told to make more frequent use of artificial tears, as well as bland eye ointments before bedtime.

If there is a history of dry eye, punctal occlusion is also recommended. Punctal occlusion involves inserting a small collagen or silicone plug in the tear drainage canal of the eye to conserve the patient's tears.

Blindfolds or goggles may also be part of the treatment plan to prevent dryness at night. However, you'll want to be sure to use a vaulted version: flat sleep masks or goggles can dry onto the surface of the cornea when people leave their eyes open a little at night, risking more injury to the cornea.

In moderately severe cases, healthcare providers will recommend a hypertonic eye drop or ointment during the day and at night. This is a salt solution that draws the fluid out of the cornea, making it very compact, and helps the epithelial cells stay more tightly adhered to the cornea. Occasionally, healthcare providers will use soft contact lenses to smooth out the cornea.

In cases in which a patient develops recurrent corneal erosions, healthcare providers will prescribe antibiotic drops. Cycloplegic drops may also be used to reduce pain and improve comfort. Cycloplegic drops calm the pain associated with inflammation by temporarily paralyzing the muscle inside the eye, which can contract strongly and cause pain. Cold compresses, chilled artificial tears, and topical non-steroidal anti-inflammatory eye drops may also be prescribed.

A Word From Verywell

If you don't respond well to medication, a procedure called anterior stromal puncture may be recommended. Anterior stromal puncture involves the healthcare provider using a sterile needle to create very small punctures in the eye's surface. These punctures do not enter the eye; they are controlled to a superficial depth, much like tattooing inserts a needle partially into the skin. This causes small scars to form and speeds healing by causing corneal cells to more securely adhere to the eye's underlying layer. Another form of treatment is photorefractive therapeutic keratectomy, or PTK, which uses a laser to smooth out the surface of the cornea and reduce symptoms.