The Corneal Sweep Test: A New Technique for Diagnosis of Recurrent Corneal Erosion

High technology concept health for eyes care – The optician ophthalmology doctor optometrist in the eyes clinic using a binocular slit-lamp to a young woman for an eye control.
The exam technique outperformed slit lamp evaluations, according to a report.

The corneal sweep test (CST) can effectively help diagnose corneal erosions in the absence of visible corneal findings among patients with recurrent corneal erosion, according to a report published in Cornea.

The findings are based on a review of the CST’s use in the private practice of Dooho Brian Kim, MD, of Professional Eye Associates in Dalton, Georgia, in 2017. Researchers conducted a retrospective chart review to evaluate the incidence and epidemiology of recurrent corneal erosion in the clinical population using standard diagnostic techniques and the CST.

Between July 2018 to June 2020, a total of 58 eyes of 51 patients (57% woman, 43% men) with diagnosis of recurrent corneal erosion were identified. Dr Kim performed comprehensive ophthalmologic examinations on all patients and performed the CST as a confirmatory test on any patient who lacked visible corneal pathology.

A novel handheld instrument, the Kim corneal sweeper (Katena, pending released) was designed specifically for conducting a CST. It has a straight handle and rounded tip with smooth tapered edges and is used to sweep the corneal surface to identify the areas of loose epithelium.

Slit lamp biomicroscopy identified 9 of the 58 eyes (15.5%) with recurrent corneal erosions. The CST was used to help confirm diagnosis of a corneal erosion in 49 of the 58 eyes (84.5%). In 34 cases, there was an occult corneal erosion, which is a new classification defined as a normal-looking cornea on slit lamp examination but with loose corneal epithelium on the CST. 

The most common presumed mechanism of injury was clear corneal cataract surgery (28/58; 48.2%). Of these eyes, 20 (71.4%) developed symptoms after cataract surgery and had an erosion located directly over a clear corneal cataract incision. 

The findings suggest that clear corneal cataract surgery may be an under-recognized but important risk factor for corneal erosion because the incision can be the source of an erosion.

Limitations of the study included the retrospective design, potential for recall bias, lack of documentation of pain scores before and after intervention, and lack of comparison of the CST with anterior segment optical coherence tomography or confocal microscopy.

Reference

Kim ME, Kim DB. Implementation of the corneal sweep test in the diagnosis of recurrent corneal erosion: a 2-year retrospective study Cornea. Published online March 17, 2022. doi:10.1097/ICO.0000000000002963