Abstract: Persistent Epithelial Defects (PEDs) present a challenging clinical scenario characterized by the failure of corneal epithelial healing despite appropriate treatment. This article provides a comprehensive exploration of PEDs, including their etiology, clinical manifestations, diagnostic approaches, and therapeutic interventions. By understanding the underlying mechanisms and implementing targeted management strategies, ophthalmologists can effectively address PEDs and promote corneal epithelial regeneration.

Introduction: Persistent Epithelial Defects (PEDs) represent a vexing ocular condition characterized by the failure of corneal epithelial healing, leading to prolonged epithelial defects and compromised visual acuity. Despite advances in ocular surface management, PEDs continue to present diagnostic and therapeutic challenges, necessitating a systematic approach to evaluation and treatment.

Etiology and Risk Factors: PEDs can arise from various etiologies, including ocular surface diseases (e.g., dry eye syndrome, neurotrophic keratopathy), traumatic injuries, contact lens-related complications, and systemic conditions (e.g., diabetes mellitus, autoimmune disorders). Identifying predisposing factors such as ocular surface irregularities, tear film abnormalities, and systemic comorbidities is crucial in addressing underlying causes and optimizing treatment outcomes.

Clinical Manifestations: The clinical presentation of PEDs varies depending on the underlying etiology and severity of corneal involvement. Patients may report symptoms such as pain, foreign body sensation, photophobia, and blurred vision. Slit-lamp examination typically reveals persistent epithelial defects, associated corneal infiltrates, and underlying stromal abnormalities, necessitating thorough ocular surface evaluation and diagnostic testing.

Diagnostic Evaluation: Diagnosing PEDs involves a comprehensive assessment of ocular surface integrity, tear film dynamics, and corneal epithelial health. Techniques such as fluorescein staining, lissamine green staining, tear film osmolarity measurement, and corneal imaging modalities (e.g., anterior segment OCT) aid in delineating epithelial defects, identifying contributing factors, and guiding treatment decisions.

Management Strategies: The management of PEDs encompasses a multifaceted approach aimed at promoting epithelial healing, reducing inflammation, and addressing underlying pathogenic mechanisms. Treatment modalities may include lubricating eye drops, bandage contact lenses, amniotic membrane transplantation, autologous serum eye drops, and surgical interventions such as corneal epithelial debridement or phototherapeutic keratectomy.

Prognosis and Follow-Up: The prognosis of PEDs depends on various factors, including the underlying etiology, extent of corneal involvement, patient compliance, and response to treatment. Close monitoring of epithelial healing, ocular surface stability, and visual outcomes is essential for adjusting therapeutic regimens and preventing disease recurrence.

Conclusion: In conclusion, Persistent Epithelial Defects (PEDs) represent a complex clinical entity requiring a tailored approach to diagnosis and management. By addressing underlying etiologies, implementing targeted interventions, and promoting ocular surface health, ophthalmologists can effectively manage PEDs and improve patient outcomes in challenging cases of corneal epithelial dysfunction.