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A 42-year-old man presents with several episodes of acute ocular pain, tearing, and photophobia which occurs immediately upon waking and improves throughout the day.  On today's examination,  focal roughening of the corneal epithelium with microcysts is seen.

This is most likely due to:

b -- epithelial basement membrane disorder   Epithelial Basement Membrane Disorder (EBMD) This is a classic clinical presentation for this disorder.  The acute management of this disorder is to use a cycloplegic drop and antibiotic ointment (for example, erythromycin).  After the epithelial defect has healed, the patient should use 5% sodium chloride drops four times a day and 5% sodium chloride ointment at bedtime.  For non-responsive cases, extended-wear bandage contact lens, anterior stromal puncture, and phototherapeutic keractectomy (PTK) can also be used to help these patients.