Eyelid Pressure Patching, AMT Safely Heals Persistent Epithelial Defects

A new retrospective analysis found a combination of eyelid pressure patching and amniotic membrane treatment (AMT) safe and effective for addressing and healing persistent corneal epithelial defects (PCED).1

Among 144 eyes, those treated with a single-layer dehydrated, decellularized amniotic membrane basement membrane (AMBM) (90%) achieved complete healing with full AMT dissolution. In contrast, eyes that received the three-layer AMBM (10%) showed improved corneal staining, though 20–30% of the AMBM remained undissolved.

“This study demonstrated the significant utility of using a dehydrated, decellularized AMBM to support healing of PCED resulting from advanced dry eye disease (DED) and neurotrophic keratitis concomitantly with an eyelid pressure patch,” wrote the investigative team, led by Kyle Linsey, DO, of the Cornea Service at Clearwater Eye and Laser Center.

Ocular surface disease (OSD) can disrupt the precorneal tear film, predisposing eyes to clinical diseases, including acute keratitis associated with PCED. When underlying risk factors, including DED, neurotrophic keratitis, and limbal stem cell deficiency, become present, they can impair normal corneal healing and lead to danger of infection, scarring, or perforation.2

Management of PCED can challenge a patient’s prognosis, but AMT can promote the re-epithelialization of PCED in refractory cases by addressing ocular surface inflammation. Deccularizated, dehydrated pure AMBM, a layer of AMT, benefits the healing of PCED by promoting cell adhesion and growth and reducing inflammation.3

AMT, combined with an eyelid pressure patch, is presumed to stabilize the ocular surface and promote healing, based on the idea that consistent pressure can maintain the position of the AMBM.4 In this observational, retrospective study, Linsey and colleagues assessed the effect of a single-layer or three-layer decellularized AMBM combined with a 24-hour eyelid pressure patch.1

Each eye in the analysis experienced a confirmed PCED resulting from DED consistent with the Dry Eye Workshop (DEWS II) lever 2–4 or Mackie stage 1–3 neurotrophic keratitis. All patients failed conventional therapy, including frequent use of artificial tears, lid hygiene, and ≥1 immunomodulatory. The average age of patients was 76.7 and 72.9% (n = 105) were female.

Among the study cohort, 129 were treated with a single-layer dehydrated, decellularized AMBM, particularly those with Mackie stage 1 neurotrophic keratitis and superficial punctate keratitis. Meanwhile, 15 patients with more severe clinical diseases, including Mackie stage 2–3 neurotrophic keratitis, received a three-layer dehydrated, decellularized AMBM.

After the 24-hour follow-up period, all (100%) patients in the single-layer group achieved complete healing and AMBM resolution. Those who received the three-layer AMBM showed residual graft, representing a non-dissolution of 20–30% of the original AMT.

All cases experienced 100% resolution of the epithelial defects, with no reports of pain or discomfort during the overnight patching procedure. At the 1-week follow-up, all patients demonstrated continued resolution of epithelial staining defects, while 100% of those receiving three-layer AMBM reported complete absorption of AMT.

Combining the AMBM with eyelid pressure patching could benefit patients in terms of comfort and quality to improve clinical outcomes. Linsey and colleagues noted the three-layer graft could benefit from extended patching times, to allow for complete dissolution and maximal regenerative impact on the corneal surface.

“More rapid and complete resolution of epithelial defects may improve patient comfort, reduce the risk of infection, mitigate scarring, and lower the risk for additional surgical interventions or prolonged treatments, enhancing overall quality of life,” Linsey and colleagues added.

References

1. Linsey, K. Use of an Eyelid Pressure Patch Concomitantly with a Decellularized Dehydrated Amniotic Membrane for Ocular Surface Disease Management. Ophthalmol Ther 14, 573–584 (2025). https://doi.org/10.1007/s40123-025-01094-2

2. Mead OG, Tighe S, Tseng SCG. Amniotic membrane transplantation for managing dry eye and neurotrophic keratitis. Taiwan J Ophthalmol. 2020;10(1):13-21. Published 2020 Mar 4. doi:10.4103/tjo.tjo_5_20

3. Katzman LR, Jeng BH. Management strategies for persistent epithelial defects of the cornea. Saudi J Ophthalmol. 2014;28(3):168-172. doi:10.1016/j.sjopt.2014.06.011

4. Meller D, Pauklin M, Thomasen H, Westekemper H, Steuhl KP. Amniotic membrane transplantation in the human eye. Dtsch Arztebl Int. 2011;108(14):243-248. doi:10.3238/arztebl.2011.0243