Post-LASIK Epithelial Ingrowth

Post-LASIK epithelial ingrowth means that some of the surface skin cells of the cornea (called epithelial cells) slide under the LASIK flap and start growing in the wrong place, between the flap and the underlying cornea. Think of the corneal flap as a hinged window cut during LASIK. Normally that window lays back down smoothly, and the edge seals. If any tiny number of surface cells get under the flap edge, they can multiply there. These cells do not belong under the flap. When they grow, they can make little white-gray “nests” or sheets. Many times they stay near the flap edge and cause no trouble. Sometimes they spread toward the center of the cornea and disturb vision. This problem can show up soon after surgery or later, especially if the flap is lifted again or if the flap edge is disturbed. (Doctors use a simple clinical grading system, described below, to decide if it just needs watching or needs treatment.) EyeWikiReview of Ophthalmology

Post-LASIK epithelial ingrowth happens when skin-like cells from the surface of the eye (the corneal epithelium) slip under the LASIK flap and start growing where they should not. Small, stable nests at the flap edge may cause no trouble; but if cells spread toward the center, they can blur vision, distort the cornea, and—rarely—lead to flap melt. Treatment ranges from careful monitoring to lifting the flap and clearing the cells; adjuvants like alcohol, mitomycin-C, sutures, fibrin glue, PTK (phototherapeutic keratectomy), or Nd:YAG laser may be used in selected cases to reduce recurrence. PMCEyeWiki+1

During LASIK, a thin flap is made on the front clear window of the eye (the cornea). The flap is lifted, laser reshapes the cornea, and the flap is laid back down. In epithelial ingrowth, a few of the surface cells hitchhike under the flap or later work their way under a tiny gap at the flap edge. Because these cells are wired to grow and cover surfaces, they can multiply between the flap and the corneal bed, forming white “islands” or a “sheet” that creeps inward. If the growth stays small and peripheral, vision may be OK. If it spreads toward the pupil, you can get blur, ghosting, glare, and irregular astigmatism; advanced cases can even warp or erode the flap (flap melt) if ignored. PMCEyeWiki

How does it happen? During LASIK, a thin flap is created and lifted. The laser reshapes the cornea. Then the flap is put back. If a few epithelial cells slip under the edge—during the first surgery, during a later flap lift for an “enhancement,” or after trauma—they can grow where they should not. Flap edges made with a femtosecond laser tend to lock like a tongue-and-groove, which lowers the risk compared with older mechanical blades, because the edge is tighter and there is less edge trauma. But the risk is not zero. PubMedAmerican Academy of Ophthalmology+1

Doctors usually see epithelial ingrowth at the slit lamp in the clinic. It often becomes noticeable between one week and one month after surgery or flap lift, but it can also appear years later if the flap edge gets disturbed. Very rarely, it can even show up many years after surgery without a clear injury. Review of OphthalmologyPMC

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Types

Doctors often use the Probst–Machat classification to grade severity. This system helps decide if the ingrowth can simply be observed or needs active treatment. I’ll explain these grades in plain English:

• Grade 1 (mild, peripheral, stable)
  A very thin layer (only one to two cell layers thick) stays close to the flap edge (usually within about 2 mm of the edge). It is often transparent and hard to see unless you look carefully. There are no changes in the flap. It does not tend to spread. Many Grade 1 cases only need regular checkups. EyeWiki

• Grade 2 (more, can creep inward)
  The nest of cells is thicker and can extend a little farther from the edge. It may start to change the way light passes through the cornea. It can progress slowly. Doctors may plan treatment within weeks or months if it keeps moving inward or starts to affect the patient’s vision. Review of Ophthalmology

• Grade 3 (pronounced, symptomatic, progressive)
  The ingrowth is several cells thick. It often produces a visible, irregular border, and the flap can show changes such as melting or an uneven interface. This grade usually affects vision and needs more urgent treatment because it can spread quickly toward the visual center. EyeWikiReview of Ophthalmology

• Grade 4 (extensive, visually threatening)
  This is the most severe end of the spectrum. The ingrowth is dense and wide, often threatening or involving the visual axis. The flap and the cornea can be damaged. This grade needs urgent, active care to protect vision. (Some publications mention grades 1–3; others describe 1–4; what matters is that more advanced disease needs faster treatment.) PMCSciELO

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Causes (Risk Factors)

Below are common situations that allow epithelial cells to sneak under the flap or help them grow once they are under the flap. Each item is one clear idea in simple terms.

1. Flap edge not sealing perfectly right after LASIK
   A tiny gap at the edge can be a door for surface cells to slide under and grow. This can occur even with careful surgery. EyeWiki

2. Lifting the flap again for an “enhancement”
   Any time the flap is lifted to adjust vision later, the edge is disturbed again. This re-opening raises the risk that cells can enter. PMC

3. Epithelial defect during surgery (surface scrape or sloughing)
   If the surface layer is scraped, sloughed, or loose during surgery, more cells are free to migrate under the flap. EyeWiki

4. Older mechanical microkeratome blades
   Flaps cut with older blades can have more edge trauma and a less “locking” side-cut shape, raising risk compared with femtosecond lasers. PubMedAmerican Academy of Ophthalmology

5. Femtosecond flaps lower (but do not eliminate) risk
   Modern laser-created flaps have tighter edges, so the risk is lower—but not zero. PubMedAmerican Academy of Ophthalmology

6. Epithelial Basement Membrane Dystrophy (EBMD)
   This common surface condition makes the epithelium stick poorly to its base, making it easier for cells to loosen and move under the flap. Review of Ophthalmology

7. Previous corneal surface disease like recurrent erosions
   A history of recurrent corneal erosions means the surface layer comes loose, again letting cells move. Review of Ophthalmology

8. Dry eye, blepharitis, or meibomian gland dysfunction
   An unhealthy ocular surface and chronic lid inflammation can loosen epithelial cells and increase risk, especially when doing a flap lift later. Review of Ophthalmology

9. Diabetes mellitus
   Diabetes can impair corneal healing and adhesion, letting cells creep under the flap more easily. Review of Ophthalmology

10. Older age
    Older corneal epithelium may adhere less strongly, increasing risk of defects and ingrowth. EyeWiki

11. Steep corneas
    A steep curvature can make flap creation and handling trickier, raising the chance of epithelial defects. EyeWiki

12. Previous corneal surgery (e.g., RK or PK)
    Past surgery can change the surface and the way the epithelium behaves, making ingrowth more likely. Review of Ophthalmology

13. History of contact lens wear
    Long-term lens wear can affect the corneal surface and its healing response. EyeWiki

14. Increased corneal thickness
    In some series, thick corneas were linked to more epithelial defects, which can precede ingrowth. EyeWiki

15. Preoperative hyperopia
    Hyperopic treatments were associated with more epithelial defects in some reports, making ingrowth more likely. EyeWiki

16. Type of microkeratome
    Some microkeratome designs create more surface trauma and more epithelial defects than others. EyeWiki

17. Trauma to the flap edge (early or late)
    A bump to the eye (even years later) can partially lift or wrinkle the edge and allow cells to enter and grow. ScienceDirect

18. Micro-injury over time without obvious trauma
    Even without a clear injury, tiny “wear and tear” at the edge many years later can uncover a path for cells. PMC

19. Inflammation at the time of surgery or enhancement
    Active external eye inflammation (like heavy blepharitis) can make surface cells looser and more mobile. Review of Ophthalmology

20. Epithelial ingrowth in the fellow eye
    If it happened in one eye, a person may be at higher risk in the other eye due to similar surface or healing tendencies. Review of Ophthalmology

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 Symptoms

Not everyone has symptoms. Many people with small, stable ingrowth feel fine. Symptoms usually happen when ingrowth grows thicker or moves toward the center of the cornea.

1. Blurry vision that does not clear fully with blinking.

2. Glare—light seems to spread or scatter.

3. Halos around lights at night.

4. Starbursts around car headlights at night.

5. Ghost images or monocular double vision (two images with one eye).

6. Fluctuating vision during the day, better at some times, worse at others.

7. Reduced contrast—fine details look washed out.

8. Increased sensitivity to light (photophobia).

9. Foreign body sensation—feels like grit or sand in the eye.

10. Mild pain or discomfort, especially with blinking.

11. Redness of the eye if irritation is present.

12. Tearing or watery eye.

13. Dry eye feeling, even when using drops.

14. Difficulty with night driving because of glare and halos.

15. Vision not improving with glasses as expected (irregular astigmatism from the interface makes glasses less helpful).

(These symptoms are non-specific and can be caused by other LASIK-related issues too, so an eye doctor needs to examine the cornea carefully to confirm the cause. Doctors use simple grading and imaging, described below, to tell ingrowth from other problems.) Review of OphthalmologyEyeWiki

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Diagnostic Tests

Below are 20 tests grouped into Physical Exam, Manual Tests, Lab/Pathological Tests, Electrodiagnostic Tests, and Imaging Tests. Each item explains what the test is, what the doctor looks for, and why it helps in plain English.

A) Physical Exam

1. Visual acuity (eye chart) testing
   You read letters on a chart. If ingrowth distorts the cornea, the letters may look fuzzy. This gives a basic measure of vision and helps track change over time.

2. Pinhole test
   You look through a tiny hole. If vision improves, the blur comes from focusing or corneal surface distortion rather than from deeper nerve problems. Ingrowth often improves a little with pinhole, but not fully if the cornea is very irregular.

3. Manifest refraction (finding the glasses number)
   The doctor uses lenses—“which is better, 1 or 2?”—to see if glasses can sharpen vision. With ingrowth, there may be irregular astigmatism, and best-corrected vision can be limited.

4. Slit-lamp biomicroscopy
   The doctor uses a bright microscope to look for white or gray nests or thin sheets of cells under the flap near the edge, often with a sharp front line. This is the key exam for diagnosis. The doctor also checks for flap edge changes or melting. Review of OphthalmologyEyeWiki

5. Fluorescein staining
   Eye drops color the tears. Under blue light, the doctor can see surface defects, edge leaks, or rough spots that may explain how cells got under the flap. It also helps separate ingrowth from inflammation on the surface.

6. Seidel test (leak check at the edge)
   With fluorescein, the doctor can check if any fluid is leaking at the flap edge. A leak is rare but can be a path for cells and germs. Ruling this out is reassuring.

B) Manual Tests

7. Cycloplegic refraction (after dilating drops)
   Drops relax the focusing muscles. This shows the “true” glasses number. It helps separate focusing spasm from corneal distortion caused by ingrowth.

8. Contact lens over-refraction (often with a rigid trial lens)
   A smooth rigid lens placed on the eye can mask an irregular corneal surface. If vision improves a lot with the lens on, the blur likely comes from surface irregularity, which ingrowth can cause.

9. Glare disability testing (e.g., with a brightness acuity tester)
   A bright light is shined during vision testing. If vision drops much more than normal, it suggests light scatter from interface changes.

10. Tear film evaluation (fluorescein tear break-up time)
    After dye, the doctor times how fast the tears “break up” into dry spots. A poor tear film worsens glare from any corneal irregularity. Improving the tear film helps symptoms even when ingrowth is mild.

C) Lab and Pathological Tests

11. Interface scraping for cytology/histology (rare, when needed)
    If the doctor lifts the flap to treat, tiny samples of the suspicious tissue can be sent to the lab. Under the microscope, the pathologist sees epithelial cells and confirms the diagnosis. Special stains like PAS or cytokeratin can help prove they are epithelial cells and not inflammatory debris.

12. Gram stain and cultures (if infection is suspected)
    If there is redness, pain, or discharge, the doctor may culture to rule out infection that can look similar at first. This protects vision by catching infection early if present.

13. Impression cytology at the flap edge
    A small filter paper can gently lift surface cells for microscope confirmation of abnormal epithelium near the edge.

14. Tear film inflammatory marker test (e.g., MMP-9 “InflammaDry”)
    This point-of-care test detects inflammation on the surface. It does not diagnose ingrowth by itself, but it uncovers surface inflammation that can worsen symptoms and healing.

D) Electrodiagnostic Tests

15. Visual Evoked Potential (VEP)
    Sticky electrodes on the head measure the brain’s response to visual patterns. This test is not used for every case. It is helpful if vision seems worse than expected and the doctor wants to be sure the optic nerve and brain responses are normal. A normal VEP points back to the cornea as the main problem.

16. Corneal esthesiometry (electronic or air-jet device)
    This measures corneal sensitivity. LASIK can reduce sensation. In some clinics, this helps document corneal nerve status. It does not diagnose ingrowth directly, but it can explain why symptoms are worse when the surface is less sensitive or poorly lubricated.

E) Imaging Tests

17. Anterior Segment Optical Coherence Tomography (AS-OCT)
    This is a painless scan that shows cross-section pictures of the flap and the layer under it. Epithelial ingrowth appears as bright (hyper-reflective) little islands, nests, or sheets under the flap, helping the doctor measure how deep and how far it extends. AS-OCT is very helpful for planning and follow-up. PubMedLippincott Journals

18. In Vivo Confocal Microscopy (IVCM)
    This is a special microscope that can zoom into living cornea cells. It can show clusters of epithelial-like cells under the flap. It helps confirm the diagnosis when the slit-lamp view is unclear. (IVCM is more specialized and not needed for every patient.)

19. Corneal topography/tomography (Placido or Scheimpflug)
    These maps show the shape and curvature of the cornea. Ingrowth can cause irregular astigmatism and “hot spots” of curvature change near the ingrowth. Mapping shows whether the cornea is distorted and how much. It also helps monitor stability after observation or treatment.

20. Wavefront aberrometry
    This test measures how light waves are distorted as they pass through the eye. Ingrowth can increase higher-order aberrations (like coma), which explains night glare and halos. Tracking these numbers helps judge if vision quality is improving or worsening over time.

Non-pharmacological treatments (therapies & “other” measures)

These are non-drug actions, techniques, or care habits your surgeon may use. Each item includes what it is, why, and how it helps.

1. Watchful monitoring for tiny, stable nests
   What: Careful observation with frequent check-ups when the growth is small, peripheral, and not moving.
   Why: Many small edge pearls stay quiet and don’t affect vision.
   How: Regular slit-lamp exams; treat only if it progresses or causes symptoms. EyeWiki

2. Patient education and eye protection
   What: Shields at night, sunglasses outdoors, and no eye rubbing.
   Why: Rubbing or trauma can open the flap edge and feed cells inward.
   How: Mechanical protection lets the flap seal and epithelium stabilize.

3. Aggressive management of surface disease
   What: Address dry eye and EBMD risks before/after any flap lift.
   Why: Fragile epithelium and poor tear film increase defects and ingrowth risk.
   How: Optimize lids/tears; defer elective relifts until the surface is healthy. EyeWiki

4. Timing & grading-based decisions
   What: Use severity scales (e.g., Probst/Machat) to decide whether to treat.
   Why: Reduces overtreatment of harmless pearls and undertreatment of advancing sheets.
   How: Treat when there’s vision drop or risk of flap melt. EyeWiki

5. Bandage contact lens (selective use)
   What: A soft protective lens after flap lift or epithelial disturbance.
   Why: Can protect healing epithelium and reduce discomfort.
   How: Acts as a temporary bandage; note that studies disagree on whether BCLs reduce or increase ingrowth risk—so surgeons use them selectively. EyeWikiPubMedCRST Global

6. Strict avoidance of routine BCL after enhancements
   What: Some surgeons avoid BCLs after flap-lift enhancements.
   Why: At least one study associated overnight BCL use with higher ingrowth rates.
   How: Reserve BCLs for clear indications (e.g., large defects). PubMedOphthalmologyWeb

7. Eyelid taping or shields during sleep (short-term)
   What: Gentle lid taping or rigid shields for a few nights.
   Why: Prevents nocturnal rubbing that can shear the flap edge.
   How: Physical barrier supports flap apposition.

8. Activity modification
   What: Pause contact sports, dusty work, or high-wind exposure early after a flap lift.
   Why: Minimizes micro-trauma that could re-open the edge.
   How: Reduces mechanical risk while the flap seals.

9. Tear-film optimization (non-drug measures)
   What: Humidifiers, frequent blink breaks, warm compresses for meibomian glands.
   Why: A healthier tear film protects epithelium from frictional injury.
   How: Improves surface stability to lower recurrent defects.

10. Mechanical micro-debridement (scraping) – core therapy
    What: Lift the flap, delicately scrape cells off the stromal bed and the underside of the flap.
    Why: Physically removes misplaced cells.
    How: The foundational step in most definitive treatments. EyeWikibmjophth.bmj.com

11. Flap-edge “sealing” with tight apposition
    What: Extra care in drying, ironing, and aligning the flap edge on repositioning.
    Why: A tight seal blocks new cells from slipping in.
    How: Reduces recurrence even without other adjuvants. EyeWiki

12. Temporary flap sutures
    What: Fine stitches at the edge after clearance.
    Why: Sutures create firm apposition, lowering recurrence without the side effects of certain chemicals.
    How: Stitches are removed once the edge is sealed. EyeWiki

13. Fibrin glue (biologic sealant) as an adjunct
    What: A bio-adhesive applied at the flap edge after cell removal.
    Why: Enhances flap adherence and blocks pathways for recurrent cells.
    How: Several series report reduced recurrence with glue. ScienceDirect+1ResearchGate

14. Ethanol-assisted cell lysis (intraoperative)
    What: Brief application of dilute alcohol during flap lift.
    Why: Kills residual epithelium that scraping might miss.
    How: Often used for recurrent cases; requires expert handling. bmjophth.bmj.com

15. Mitomycin-C (MMC) adjuvant (intraoperative)
    What: A micro-dose of antimetabolite applied for seconds.
    Why: Inhibits cell proliferation, lowering repeat growth risk.
    How: Used sparingly due to potential toxicity if misused. bmjophth.bmj.com

16. Phototherapeutic keratectomy (PTK)
    What: An excimer laser polishes the surface after lifting/scraping.
    Why: Improves adhesion between flap and bed and removes residual cells/irregularities.
    How: Helpful for recurrent or central ingrowth. Wiley Online Library

17. Nd:YAG laser disruption (selected early cases)
    What: Office laser “spotting” to break up small interface nests.
    Why: Can destroy early cells without lifting the flap, avoiding surgical risks.
    How: Useful for small, peripheral, or postoperative cases—but rare complications have been reported, so selection is key. ScienceDirectHealio Journals

18. Careful choice of enhancement strategy
    What: Weigh relifting the flap vs. surface ablation (PRK) for retreatments.
    Why: Relifting a very old flap can be harder and raises ingrowth risk; surface ablation has its own trade-offs (pain, haze).
    How: Decision is individualized to reduce new ingrowth risk. EyeWorld

19. PTK/PRK “rescue” for complex retreatments
    What: Trans-PTK or PRK used to restore clarity/regularity after ingrowth is cleared.
    Why: Helps smooth optical zone and improve vision in scarred/irregular corneas.
    How: Newer reports show promising results in selected cases. Lippincott Journals+1

20. Flap amputation (rare last resort)
    What: Removing a damaged or melting flap when all else fails.
    Why: Eliminates the compartment where cells grow.
    How: Reserved for severe, recurrent cases threatening the eye. (Discussed in reviews as exceptional salvage.) bmjophth.bmj.com

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Drug treatments

Medicines do not erase ingrowth by themselves. They support surgery, comfort, and healing. Doses below are common examples only—your surgeon will tailor and prescribe.

1. Topical fluoroquinolone antibiotic (e.g., moxifloxacin 0.5% q.i.d. for ~1 week post-procedure)
   Class: Antibiotic.
   Purpose: Prevent infection after flap lift/scraping.
   Mechanism: Blocks bacterial DNA enzymes.
   Side effects: Mild sting, rare allergy; very rare white deposits.

2. Topical corticosteroid (e.g., prednisolone acetate 1% q.i.d., then taper)
   Class: Anti-inflammatory steroid.
   Purpose: Calm interface inflammation and reduce haze/DLK risk after manipulation.
   Mechanism: Suppresses inflammatory cytokines.
   Side effects: Temporary eye-pressure rise, delayed epithelial healing if overused.

3. Mitomycin-C 0.02% (intraoperative micro-application for seconds)
   Class: Antimetabolite/antifibrotic.
   Purpose: Lower recurrence by inhibiting epithelial proliferation.
   Mechanism: Cross-links DNA, halting cell division.
   Side effects: Corneal toxicity if misused; therefore surgeon-applied only. bmjophth.bmj.com

4. Ethanol 20% (brief intraoperative application)
   Class: Chemical cytolytic agent.
   Purpose: Lyse any residual epithelial cells.
   Mechanism: Disrupts cell membranes/proteins.
   Side effects: Surface toxicity if overexposed; expert use required. bmjophth.bmj.com

5. NSAID eye drops (e.g., ketorolac 0.5% or nepafenac 0.1%)—use judiciously
   Class: Non-steroidal anti-inflammatory.
   Purpose: Pain control; adjunct inflammation control.
   Mechanism: COX inhibition → less prostaglandin.
   Side effects: Stinging, rare delayed epithelial healing—use under supervision. PMC

6. Hypertonic saline 5% (short course if flap edema present)
   Class: Osmotic agent.
   Purpose: Reduce interface edema that can worsen optical quality.
   Mechanism: Draws fluid out of the cornea.
   Side effects: Temporary burning.

7. Artificial tears (preservative-free, frequent)
   Class: Lubricant.
   Purpose: Reduce friction, support epithelial healing.
   Mechanism: Replaces/stabilizes tear film.
   Side effects: Minimal; choose preservative-free for frequent use.

8. Combination antibiotic–steroid drops (short course if indicated)
   Class: Dual therapy.
   Purpose: Convenience when both infection prevention and inflammation control are needed.
   Mechanism: As above.
   Side effects: As above (pressure check if used >1–2 weeks).

9. IOP-lowering drops (e.g., timolol) if steroid-response spike occurs
   Class: Beta-blocker/other antiglaucoma agents.
   Purpose: Prevent optic nerve stress from steroid-related pressure rise.
   Mechanism: Lowers aqueous production or improves outflow.
   Side effects: Depends on agent; coordinated by your ophthalmologist.

10. Cycloplegic/mydriatic (e.g., cyclopentolate PRN)
    Class: Antimuscarinic.
    Purpose: Ease ciliary spasm–related pain and light sensitivity after flap manipulation.
    Mechanism: Temporarily relaxes focusing muscle and dilates the pupil.
    Side effects: Blurry near vision, light sensitivity.

Note: Fibrin glue is a biologic sealant (applied by the surgeon), often classified as a device/biologic rather than a “drug,” but it acts like a medicinal adjunct to reduce recurrence. ScienceDirect

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Dietary molecular supplements (supportive; not a cure)

Nutrition cannot remove epithelial ingrowth, but a well-nourished surface heals better. Discuss supplements with your doctor, especially if you’re pregnant, on blood thinners, or have chronic illness.

1. Omega-3 fatty acids (EPA/DHA 1–2 g/day)
   Function: Supports tear quality and anti-inflammatory balance.
   Mechanism: Competes with arachidonic acid pathways → fewer pro-inflammatory mediators.

2. Vitamin C (ascorbic acid 500–1000 mg/day)
   Function: Collagen co-factor; antioxidant for wound healing.
   Mechanism: Supports collagen cross-linking and scavenges free radicals.

3. Vitamin A (dietary sources preferred; avoid high-dose pills unless deficient)
   Function: Epithelium health.
   Mechanism: Regulates mucin and epithelial differentiation.

4. Zinc (10–20 mg/day with food)
   Function: Enzyme co-factor in tissue repair.
   Mechanism: Supports DNA/RNA polymerases in healing cells.

5. Lutein & Zeaxanthin (10 mg/2 mg daily)
   Function: Antioxidant support for ocular tissues.
   Mechanism: Quenches reactive oxygen species in ocular surface/retina.

6. Vitamin D3 (check blood level; often 1000–2000 IU/day)
   Function: Immune modulation; supports barrier function.
   Mechanism: Modulates innate/adaptive immune signaling.

7. N-acetylcysteine (NAC 600 mg once or twice daily)
   Function: Mucin precursor; antioxidant.
   Mechanism: Replenishes glutathione; can improve tear film quality.

8. Curcumin (standardized extract 500–1000 mg/day with pepper or lipid vehicle)
   Function: Systemic anti-inflammatory support.
   Mechanism: Down-regulates NF-κB pathways.

9. Resveratrol (100–250 mg/day)
   Function: Antioxidant/anti-inflammatory adjunct.
   Mechanism: Sirtuin activation, free-radical scavenging.

10. Coenzyme Q10 (100–200 mg/day)
    Function: Mitochondrial support in healing tissues.
    Mechanism: Electron transport cofactor; antioxidant.

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Regenerative / immune-modulating” therapies

There are no approved stem-cell drugs for PLEI. The items below are adjuncts your doctor may consider to support epithelium healing or modulate the surface. Some are off-label for this use—your surgeon will decide.

1. Autologous serum tears (20–50%, 4–8×/day)
   Function: Biologic eyedrops made from your blood serum.
   Mechanism: Provides epithelial growth factors and vitamins that support corneal healing; helpful in difficult surface recovery.

2. Platelet-rich plasma (PRP) tears (per protocol)
   Function: Higher platelet growth factors than serum.
   Mechanism: Delivers PDGF/EGF/TGF-β to stimulate epithelial repair.

3. Cenegermin 0.002% (six times daily × 8 weeks)
   Function: FDA-approved nerve growth factor drop for neurotrophic keratitis; occasionally used off-label to support corneal healing under specialist care.
   Mechanism: Promotes corneal nerve/epithelial recovery.

4. Topical cyclosporine A 0.05–0.1% (b.i.d.)
   Function: Immunomodulator for chronic dry eye; improves tear film and goblet cells.
   Mechanism: Calcineurin inhibition → reduced T-cell-mediated surface inflammation → better epithelial environment.

5. Lifitegrast 5% (b.i.d.)
   Function: Another anti-inflammatory dry-eye agent that can improve surface homeostasis.
   Mechanism: LFA-1/ICAM-1 blockade → fewer inflammatory signals on the ocular surface.

6. Amniotic membrane (cryopreserved or dehydrated; in-office placement)
   Function: Regenerative scaffold that releases anti-inflammatory and pro-healing factors.
   Mechanism: Biological matrix (heavy-chain hyaluronan, growth factors) that encourages epithelial re-epithelialization and quiets inflammation.

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Surgical/procedural options

1. Flap lift + thorough scraping (bed and flap underside)
   Why: Gold-standard first step to remove ingrown cells and restore a clean interface.
   How: Surgeon lifts the flap, sweeps away cells, irrigates, and replaces the flap. EyeWiki

2. Add a sealing method: tight apposition ± sutures
   Why: A snug edge stops new cells from slipping in; sutures lower recurrence.
   How: Edge is dried, carefully seated; fine sutures may be placed then removed later. EyeWiki

3. Biologic glue (fibrin) at the edge
   Why: Improves adhesion and blocks epithelial migration, especially in recurrent cases.
   How: Applied after debridement; has shown favorable outcomes. ScienceDirect

4. Adjuvant cytolysis: ethanol or mitomycin-C
   Why: Destroys residual cells that scraping can miss.
   How: Very short, controlled application under the flap during surgery. bmjophth.bmj.com

5. PTK or Nd:YAG laser in selected cases
   Why: PTK can polish the interface and improve flap-bed bonding; early, small nests may be YAG-disrupted without a flap lift.
   How: Chosen for recurrences, central involvement, or when surgery poses higher risk; note that YAG has successes and rare complications, so candidacy matters. Wiley Online LibraryScienceDirectHealio Journals

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Prevention tips (before and after surgery/enhancements)

1. Careful screening for EBMD and fragile epithelium; postpone elective surgery if unstable. EyeWiki

2. Prefer femtosecond flaps when appropriate; they tend to have lower ingrowth risk. Lippincott Journals

3. Minimize epithelial trauma during surgery and any flap lift. EyeWiki

4. Meticulous interface cleaning before the flap is laid back. EyeWiki

5. Seal the edge well; consider sutures in high-risk situations. EyeWiki

6. Avoid routine overnight bandage lenses after enhancements; use only when clearly indicated. PubMed

7. Treat dry eye and lid disease to protect epithelial integrity. EyeWiki

8. No eye rubbing; use shields during sleep in the early healing window.

9. Prompt care for any epithelial defect (scratch, erosion). EyeWiki

10. Smart timing of enhancements and individualized plan to lower ingrowth risk. EyeWorld

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When to see a doctor (don’t wait)

• Any new blur, ghosting, haloes, or glare after LASIK.

• A white/gray smudge or fan-shaped streak at the flap edge you can see in the mirror.

• A sense your vision is worsening week to week.

• Pain, light sensitivity, or sudden irritation.

• If you recently had a flap lift/enhancement and notice changes.

Seek same-day assessment; early intervention prevents bigger problems. EyeWiki

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What to eat  and what to avoid

Eat more of:

1. Oily fish (salmon, sardines) for omega-3s.

2. Colorful vegetables (spinach, kale) for lutein/zeaxanthin.

3. Citrus/berries for vitamin C.

4. Orange/yellow veg (carrots, pumpkin) for vitamin A precursors.

5. Nuts/seeds (walnuts, flax, chia) for healthy fats.

6. Eggs (yolk nutrients including lutein).

7. Lean proteins (repair amino acids).

8. Legumes and whole grains (zinc and B-vitamins).

9. Water—steady hydration supports the tear film.

10. Fermented foods or yogurt (supports balanced immunity).

Limit/avoid:

1. Smoking and secondhand smoke (impairs healing).

2. Excess alcohol (dehydrates eyes).

3. Very high-sugar/ultra-processed foods (pro-inflammatory).

4. Deep-fried foods (oxidized oils).

5. Spicy foods if they worsen facial sweating/eye rubbing.

6. Very dry, windy environments without eye protection.

7. Poor sleep (hurts tissue repair).

8. Rubbing your eyes (mechanical risk).

9. Contact sports without shields while healing.

10. Skipping follow-ups (misses early progression).

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FAQs

1) Can epithelial ingrowth go away on its own?
Small, stable edge pearls can remain harmless with monitoring. If it spreads or blurs vision, treatment is needed. EyeWiki

2) How do doctors grade it?
They look at location, size, and progression (e.g., Probst/Machat). Treatment is based on whether it threatens vision or the flap. EyeWiki

3) What is the most common treatment?
Lift the flap and thoroughly scrape the cells off both surfaces, then seal the edge securely. EyeWiki

4) Will it come back after scraping?
It can. Recurrence after scraping alone has been reported; adding sutures or glue, and careful edge sealing, lowers the risk. EyeWikiScienceDirect

5) Are chemical adjuvants safe?
Ethanol and mitomycin-C are used in tiny, controlled doses by surgeons to reduce regrowth; benefits must be weighed against potential toxicity. bmjophth.bmj.com

6) Is Nd:YAG laser an option?
Sometimes, for small/early nests. Reports show good success in selected cases, but rare complications exist—your surgeon will judge candidacy. ScienceDirectHealio Journals

7) What about PTK?
PTK can improve flap-bed adhesion and surface regularity, useful in recurrent or central cases. Wiley Online Library

8) Do bandage contact lenses help or hurt?
They protect healing in certain scenarios, but some studies link routine post-enhancement BCL use to higher ingrowth—so use is selective. EyeWikiPubMed

9) Is it more common with enhancements?
Yes—relifting a flap raises risk compared with primary LASIK, especially with older microkeratome flaps and fragile epithelium. Review of OphthalmologyResearchGate

10) Do femtosecond flaps help?
They’re associated with lower ingrowth rates than older mechanical flaps. Lippincott Journals

11) Could ingrowth cause permanent damage?
If ignored, progressive sheets can distort the cornea or even melt the flap—hence the need for timely care. EyeWiki

12) How fast can it appear?
Sometimes within weeks; sometimes later, especially after a flap lift years down the line. Review of Ophthalmology

13) Can nutrition or vitamins cure it?
No. Nutrition supports healing, but mechanical ingrowth usually needs procedural treatment if progressive.

14) Is PRK a better choice than relifting for enhancements?
It depends. PRK avoids lifting the flap (so less ingrowth risk) but has more discomfort and potential haze; your surgeon weighs risks/benefits. EyeWorld

15) What’s the bottom line for prevention?
Pick the right timing, protect the epithelium, seal the edge well, and avoid rubbing. If you notice new symptoms, get checked right away. EyeWiki+1

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 22, 2025.