Decision-making in the therapy of external eye disease: noninfected corneal ulcers.

Despite diverse and multiple clinical etiologies, the pathogenesis of noninfected corneal ulcers consistently relates to persistent or extensive epithelial defects, concomitant with stromal inflammatory cell infiltration and enzymatic degradation of collagen and ground substance. The therapeutic approaches to these disorders may be considered on three levels: (1) the determination of etiology and initiation of primary therapy; (2) promotion of epithelial healing; and (3) limitation of ulceration and support of repair, the latter aspects currently featuring pharmacologic management and limited surgical modalities, particularly the use of tissue adhesive.