What topical agent is most widely used to promote corneal re‑epithelialisation?

Topical Agents for Corneal Re-epithelialization

Autologous serum eye drops (20% concentration) are the most widely used and effective topical agent to promote corneal re-epithelialization, particularly for persistent epithelial defects that fail conventional therapy. 1, 2, 3

Primary Treatment Options

Autologous Serum Eye Drops (First-Line for Persistent Defects)

• 100% autologous serum demonstrates superior efficacy compared to diluted preparations (50% with normal saline, sodium hyaluronate, or ceftazidime) for promoting epithelial healing in both Sjögren's syndrome and persistent epithelial defects 3
• Applied 8 times daily, autologous serum achieves complete re-epithelialization of persistent defects within 2-3 weeks in cases refractory to conventional therapy 1, 2
• Continued use for 2 weeks after complete healing significantly reduces recurrence rates (50% recurrence without continued use vs. minimal recurrence with continued use) 1
• Mechanism includes reducing inflammation (decreased CD45+ cell infiltration) and promoting proliferation (increased Ki-67+ cells) 4

Combination Therapy for Optimal Results

• Autologous serum combined with silicone-hydrogel soft contact lenses provides the most effective treatment for recalcitrant persistent epithelial defects, including chemical burn-induced cases 1, 2
• This combination stabilizes the ocular surface while delivering growth factors and anti-inflammatory components 2

Adjunctive Therapies for Re-epithelialization

Topical Antibiotics (Prophylactic Role)

• Fluoroquinolones (moxifloxacin 0.5% or gatifloxacin 0.5%) applied 4 times daily prevent secondary bacterial infection during the healing process but do not directly promote re-epithelialization 5, 6
• The American Academy of Ophthalmology emphasizes that antibiotics should be started within 24 hours of epithelial injury to prevent ulceration 5, 6
• Antibiotic ointments (including tetracycline) lack corneal penetration and are relegated to bedtime use as adjunctive therapy only, not as primary re-epithelialization agents 5

Amniotic Membrane Products

• Topical cryopreserved amniotic membrane and umbilical cord (AMUC) eye drops significantly accelerate re-epithelialization (3.15 vs. 4.00 days in animal models) by reducing inflammation and promoting proliferation 4
• Amniotic membrane coverage may be considered for persistent defects when infection is controlled, but is not first-line for routine cases 7, 6

Lubrication and Surface Rehabilitation

• Preservative-free artificial tears and antibiotic ointments serve as adjunctive therapies when persistent epithelial defects occur despite infection control 7
• Adequate blinking and complete eyelid closure are critical for healing; temporary tarsorrhaphy may be necessary when these are inadequate 6

Critical Management Principles

What NOT to Use

• Avoid topical corticosteroids during active re-epithelialization as they delay healing and increase infection risk 7, 6
• Steroids may only be considered after 2-3 days of antibiotic therapy once infection is controlled and organism identified 5
• Never patch the eye as this does not improve healing and may increase bacterial keratitis risk 5, 6
• Bandage contact lenses should be avoided in contact lens wearers due to infection risk 5

Treatment Algorithm

1. For simple corneal abrasions: Fluoroquinolone drops 4 times daily + antibiotic ointment at bedtime 5, 6
2. For persistent epithelial defects (>2 weeks): Add 20% autologous serum 8 times daily 1, 2, 3
3. For refractory cases: Combine autologous serum with silicone-hydrogel contact lens 1, 2
4. After complete healing: Continue autologous serum for additional 2 weeks to prevent recurrence 1

Common Pitfalls to Avoid

• Discontinuing autologous serum immediately after re-epithelialization leads to 50% recurrence rates; always continue for 2 additional weeks 1
• Using diluted autologous serum (50%) instead of 100% concentration reduces efficacy, particularly in Sjögren's syndrome and severe cases 3
• Chronic prophylactic antibiotic use beyond the healing period promotes resistant organisms 5, 6
• Inadequate patient education about infection warning signs (increasing pain, purulent discharge, vision changes) delays recognition of complications 5, 6