When bulging, these blebs can cause symptoms as they interfere with blinking and tear flow. Management can include lubricants and tear supplements, as well as staged removal of sectors of conjunctiva, away from the functioning upper quadrant. The anterior edge of the bleb extends over the cornea within the epithelium, forming a white, nonvascularized, multiloculated, and spongy tissue, which can protrude for several millimeters. The Bowman layer and stroma remain intact. This condition can cause symptoms when it interferes with blinking or tear flow, causes bubble formation, or irritates corneal nerves.
Management can include lubricants and tear supplements.
If not effective, the part of the bleb lying over the peripheral cornea can be excised under topical anesthesia at the slit lamp or under a surgical microscope in the minor operating room. Simple excision without suturing or grafting is usually sufficient. Dellen Corneal dellen develop in front of steep-walled blebs placed either nasally or temporally. The bulk of the bleb impedes the contact of the inner surface of the upper lid with the peripheral cornea Lubricants and tear supplements are indicated for management, and they need to be used intensively. Ointments and patching are the next levels of intervention.