**6.9 Persistent epithelial defect**

Great attention should be focused on the tear condition, ocular surface, and lids before a patient is scheduled for corneal transplantation. Optimization of the ocular surface by lid care, lid surgery, and fornix reconstruction before attempting a corneal graft prevents delayed epithelial healing in special cases. However, management of persistent epithelial defects includes frequent nonpreserved lubricants, reduction or cessation of application of any preserved eye drop, and bandage soft contact lens. Care must be taken to recognize herpetic corneal ulceration and to treat it appropriately. In special resistant cases tarsorraphy and punctal occlusion of inferior or both puncta works well. Application of the autologous serum augments the epithelialization of the cornea. Rare unresponsive cases may lead to stromal opacification or vascularization and require regrafting.
