What is Advancing Wavelike Epitheliopathy?
Advancing wavelike epitheliopathy (AWE) is a long-term or recurring condition that’s defined by clear, wave-like patches on the cornea, which is the front surface of the eye. The patches are usually rough and thickened. They usually start from the upper edge of the cornea, spreading towards the center. However, some cases have shown that it can also start from the lower edge. When the surface layer of the cornea is examined, there are no signs of abnormal growth or irregularities, and the conjunctiva (the clear tissue covering the eye) is typically not affected. AWE could affect one or both eyes.
What Causes Advancing Wavelike Epitheliopathy?
The exact cause of advancing wavelike epitheliopathy, a condition affecting the cornea, is still unknown. However, it seems like it might be due to irritation or damage to the corneal surface. There are a lot of possible triggers for this condition including past eye surgeries, wearing contact lenses, certain eye drops or medicines, exposure to harmful substances, or ongoing inflammation or skin conditions.
Some specific medications that could potentially trigger this include eye drops for glaucoma, 5-fluorouracil, topical acyclovir, and contact lens solution.
It might also be linked to certain disease processes such as ocular cicatricial pemphigoid (a condition that causes scarring of the eyes), acne rosacea, or atopic dermatitis (a type of skin inflammation).
Risk Factors and Frequency for Advancing Wavelike Epitheliopathy
Advancing wavelike epitheliopathy, a condition that typically starts after the age of 40, can affect one or both eyes. It impacts males and females equally.
Signs and Symptoms of Advancing Wavelike Epitheliopathy
Patients suffering from AWE often have problems with their vision. It might deteriorate slowly over time or alternately improve and worsen over several months or years. They often feel like there’s something in their eye, and may have teary, red, or irritable eyes. However, if the condition isn’t severe and doesn’t affect the main area of vision, they may not notice any symptoms. It’s also linked to previous eye surgery or injury, eye medications, skin conditions such as atopic dermatitis or acne rosacea.
Diagnosis of AWE is done using an examination process that includes a slit-lamp exam with fluorescein staining and confocal microscopy, both revealing specific findings that aid in diagnosing the condition.
Testing for Advancing Wavelike Epitheliopathy
Diagnosing advancing wavelike epitheliopathy, a condition related to the eye, involves using special tools like a slit lamp and confocal microscopy. This is usually done by an eye doctor. A slit lamp is a device that shines a bright light into the eye and provides a detailed view of its structures. This examination will typically reveal a well-defined, wave-like plaque starting from the upper boundary of the eye’s clear front surface. Using another technique called sclerotic scatter, the doctor may note a grainy texture and clear edges of the damaged area.
There might also be a subtle haze present in the subepithelium, the layer just under the surface, without any distinct opacities or infiltrates. In order to get a better look at the damaged area, a fluorescein staining might be carried out. This involves the use of a special dye that makes it easier to spot the problematic areas, which would show up as a dotted pattern with clear boundaries.
Another important tool in this diagnosis is confocal microscopy, a special microscope known for its ability to provide highly detailed, sharp images of the eye’s structures. With this, your doctor may find unusual, elongated cells with bright nuclei that are oriented towards the center, a larger proportion of nucleus to other parts of the cell, and the loss of clear cell borders in the basal (lowermost) layer of the cornea surface.
Treatment Options for Advancing Wavelike Epitheliopathy
The typical treatment for advancing wavelike epitheliopathy, a type of eye condition, includes removing possible offending agents, cleaning the abnormal part of the eye (debridement of the abnormal epithelium), and applying a special solution (a 1% silver nitrate solution) to a certain part of the eye (the superior corneoscleral limbus).
This special solution is not typically available pre-made, but it can be made by sterile compounding pharmacies. When using this solution for treatment, the affected eye is first numbed, then a cotton applicator soaked in the silver nitrate solution is gently rolled onto the affected area. The eye is then rinsed with a saline solution, covered with a bandage contact lens, and an antibiotic is given for 1 week. The bandage lens can be removed after 3 to 4 days, when the cornea has healed.
This treatment usually helps to reduce symptoms within two weeks, with the affected area of the eye regaining its normal appearance. Most people recover full vision in the affected eye, although occasionally some people experience a small permanent decrease in vision. For those who don’t experience symptoms, simply removing the causative agent may be sufficient for resolving the problem.
Silver nitrate likely works by encouraging cell death or changing the abnormal stem cells that are causing the problem. One study found that liquid nitrogen could also produce similar results.
Debridement of the eye, on its own, can lessen symptoms for a short period of time but is likely to be followed by recurrence of the condition and the need for re-treatment after a few months. Some theories suggest that abnormal limbal stem cells could be the cause of the problem and should be targeted for treatment.
Eye treatments like artificial tears and steroids were less effective in treating this condition and were halted due to an increase in eye pressure. Saline solution, antibiotics, and therapeutic contact lenses also showed little to no benefit in treating advancing wavelike epitheliopathy.
Because this condition shares similarities with partial limbal stem cell deficiency, there’s a possibility that some treatments effective for that might also help with advancing wavelike epitheliopathy. These could include topical retinoids, topical cyclosporine, autologous topical serum drops, and interferon-alpha-2b. However, further clinical trials are necessary to validate these treatments.
What else can Advancing Wavelike Epitheliopathy be?
There are several eye diseases that might show symptoms similar to advancing wavelike epitheliopathy, a condition affecting the cornea. However, these conditions can be confirmed or ruled out depending on the physical examination results and the disease’s response to treatment. The possible diseases include, but are not limited to:
- Corneal intraepithelial neoplasia (a condition affecting the eye’s surface)
- Corneal epithelial dysplasia (abnormal growth or development of cells in the eye’s surface)
- Squamous cell carcinoma (a type of skin cancer that can affect the eye)
- Carcinoma in situ (an early stage cancer that hasn’t spread)
- Hereditary benign intraepithelial dyskeratosis (a rare, inherited disorder characterized by lesions in the eye)
- Corneal pannus (growth of blood vessels into the cornea)
- Corneal epithelial keratinization (formation of a protein in the eye’s surface)
- Contact lens-induced keratopathy (damage to the eye from contact lens use)
- Superior limbic keratoconjunctivitis (a chronic inflammation of the eye’s surface)
- Prominent epithelial basement membrane dystrophy (an inherited condition affecting the cornea)
- Whorled microcystic dystrophy (another inherited condition affecting the cornea)
- Underlying dermatologic or inflammatory disorders (skin or autoimmune conditions that may affect the eyes).
It is crucial for doctors to distinguish between these conditions for an accurate diagnosis and treatment plan.
What to expect with Advancing Wavelike Epitheliopathy
Most people have good outcomes with silver nitrate treatment for eye conditions, leading to their vision returning to normal. However, in rare cases, some might experience slight, permanent vision loss. Occasionally, there may be small areas of abnormal tissue left after treatment. These areas, though, are almost always on the outer edges of the cornea, so they should not interfere with central vision. Recurrence of the condition is less common and is usually not as severe. If it does occur, it typically happens outside the central vision area, so more treatment is often not needed.
Possible Complications When Diagnosed with Advancing Wavelike Epitheliopathy
Though infrequent, complications can arise from certain treatments. These can include injuries to the cornea, known as corneal abrasions, and treatments that don’t fully resolve the issue, leading to the need for additional treatment.
Preventing Advancing Wavelike Epitheliopathy
If you’re diagnosed with a condition known as advancing wavelike epitheliopathy, it’s best to figure out any potential triggers and avoid them going forward. If you are a regular contact lens wearer, make sure you’re taking good care of your lenses and not wearing them for too long. If you think your current multipurpose contact lens solution might be contributing to the problem, it might be a good idea to switch to a hydrogen peroxide solution instead.
