What to do when the surface of your eye gets “broken” (scratched, operated on, infected or otherwise damaged).

When an eye gets scratched, or operated on, or has a dryness-related - or infection-related problem - that surface has to heal and healing comes from healthy tears and what is otherwise (hopefully) a healthy surface, populated with vigorous cells ready to spread rapidly across the injured area and “mend” it. 

When I was taking care of children’s eyes earlier in my career I noticed how quickly these eyes would heal, commonly overnight - even when the surface had been badly scratched or otherwise injured. This appeared to be in part due to their young age and very vigorous, healthy, reparative cells - as well as their very healthy tears. When I see older adults who have injured eyes - either intentionally from surgery, or accidentally from scratches, other trauma or chemicals, or infections, or even just dryness, then it can take a lot longer to heal and lead to bigger problems like scarring and loss of vision. 

The best option to heal many eye surface injuries is to protect that surface during the healing phases, commonly with what is called a bandage contact lens. These plastic lenses are soft and breathable and applied in the office with the ability to stay in place for weeks at a time - and allow the surface to heal underneath that bandage. Every time you blink or experience normal, dry puffs of air against the eye, this can blow-dry the surface trying to heal, even as tidal waves of tears (good or bad) and blinking-related friction of eyelids going back-and-forth over this rough, tentative surface can constantly erode that surface and prevent the healing. A contact lens can often provide that more stable, smooth surface for best healing. An alternative can be to patch the eye closed, sometimes with an ointment to help in the healing process, at the expense of blocking vision from the patch-closed eye, while the contact lens is clear and can allow vision depending on the extent of the injury. It is also easier to apply medications, if required (often an antibiotic and sometimes a steroid) to speed healing.

When tears have been a problem - as in Dry Eye patients - it is sometimes particularly helpful to apply a biologic membrane called amnion, (either dried membranes or frozen membranes, each of which have been specially treated to prevent a transfer of infectious material between the donor and the patient). The amnion is the membrane around a baby, while in a mothers womb, that holds the amniotic fluid or “water“ that contains many of the nutrients and healing factors that help the baby grow quickly and healthfully in the mothers womb. Once the baby is born, the membranes are no longer needed and would be commonly disposed of - but scientist have figured out how to preserve these membranes in a way where they can either be fixed to a ring and then deep-frozen - or dried out and packaged like a thin wafer. When applied to the eye as a kind of contact lens (Prokera-type amnion membranes are the frozen type, or small portions can be cut out and dried in a way that helps to preserve many of these factors. From my understanding of the science and from my clinical experience, when eyes are badly damaged or have terrible tears, the Prokera type membranes offer more of the healthful, supportive materials to help heal faster and better - but the patient has to put up with the plastic ring supporting this as a contact lens over the eye. The ring supports the membrane against the eye  and retains the membrane until it dissolves. This limits vision (a bit like looking through waxed paper) and can sometimes be a bit uncomfortable. Depending on the kind of injury or infection, regular visits will be scheduled, but always requires a visit within 7 to 10 days to the doctor's office in order to evaluate and usually to remove the ring (as the membrane commonly dissolves over this time). The alternative to a Prokera, is a dissolvable, dried amnion membrane, which is applied under one of the bandage contact lenses. As it dissolves, the vision gradually clears as the bandage-contact-lens takes over and eyes can sometimes go as long as weeks before being reevaluated or having the plastic ones removed - sometimes by the patient - but more frequently by the doctor. 

The universal truth is that tears are the "lifeblood" of the eye's surface - and are necessary for effective healing and support. If the tears are barely supportive, then it is sometimes an injury, infection or surgery that finally uncovers the borderline nature of the tears. The best healing happens with the best tears - so it is often necessary to fix the ability to make good tears, even as we help nurse eye injuries back to health. A contact lens (amnion or otherwise) may help jumpstart healing (amnion being a bit like putting the damaged surface back in the mother's womb), but unless you can make good tears, the surface remains at risk for further damage and poor healing. Since every case is different, it is best to work with a good dry eye specialist to help you.