Severe dry eye disease is a complex condition that affects both comfort and vision. Patients with advanced cases often experience persistent burning, foreign body sensation, blurred vision, and inflammation that do not improve with conventional therapies such as artificial tears, lubricating ointments, or even prescription eye drops. When the corneal surface becomes severely damaged or does not heal properly, advanced treatment options are needed to restore ocular health. One such treatment is the use of amniotic membranes. Amniotic membrane therapy has gained increasing attention in recent years because it promotes healing, reduces inflammation, and protects the ocular surface in ways that traditional therapies cannot achieve.
This article will review what amniotic membranes are, how they are prepared for clinical use, why they are used in severe dry eye disease, and the advantages they provide in restoring ocular health.
What Are Amniotic Membranes
The amniotic membrane is the innermost layer of the placenta that surrounds a developing fetus. It is a thin but biologically active tissue that provides protection and facilitates healing. The membrane contains growth factors, anti-inflammatory proteins, and other biologically active molecules that naturally support regeneration and reduce scarring. These unique properties make amniotic membranes a valuable material for medical use in many fields, including ophthalmology.
When applied to the eye, the amniotic membrane serves as a biological bandage. It covers the damaged corneal or conjunctival surface, protecting it while delivering healing factors directly where they are needed. Unlike synthetic materials, the amniotic membrane integrates with the ocular environment, encouraging natural repair processes.
How Amniotic Membranes Are Prepared for Use
Donor amniotic membranes are collected under strict medical standards following childbirth, with consent from the mother. The membranes are carefully processed to remove any cellular material that could cause an immune reaction. They are then sterilized and preserved through cryopreservation or dehydration, creating a safe and effective medical device.
In ophthalmology, amniotic membranes are available in different forms. Cryopreserved membranes are stored frozen and retain many of the biological components that support healing. Dehydrated membranes are room-temperature stable and easy to store, making them convenient for clinical use. Both forms are effective, and the choice often depends on the patient’s condition and the treating physician’s preference.
How Amniotic Membranes Are Used for Severe Dry Eye
Amniotic membranes can be applied in several ways depending on the severity of the condition. In many cases of severe dry eye, the membrane is placed onto the corneal surface using a specialized ring or lens-like device that holds it in place. The membrane covers the damaged area and remains on the eye for several days while the healing process begins.
During this time, the patient may experience mild blurred vision due to the membrane and its carrier device, but this is temporary. Once the membrane has dissolved or is removed, patients often notice significant improvement in comfort and, in some cases, vision. The procedure is performed in an office setting, is minimally invasive, and does not require surgery.
Why Amniotic Membranes Are Used for Severe Dry Eye
Dry eye disease can range from mild to severe. In mild forms, artificial tears and prescription medications may provide relief. However, in severe cases, chronic inflammation and epithelial damage prevent the cornea from healing on its own. The constant breakdown of the surface can lead to non-healing epithelial defects, recurrent erosions, scarring, and even vision loss.
Amniotic membranes are used when the ocular surface requires more than lubrication and anti-inflammatory drops. The biologically active proteins and growth factors in the membrane actively reduce inflammation, promote epithelial regeneration, and prevent fibrosis. This makes them especially valuable for patients who have not responded to other treatments and are at risk of permanent corneal damage.
Biological Mechanisms of Amniotic Membrane Therapy
The therapeutic effects of amniotic membranes are related to their unique biological properties. They contain natural anti-inflammatory proteins that suppress cytokines and other molecules responsible for chronic inflammation in dry eye disease. They also provide growth factors that stimulate epithelial cells to proliferate and migrate across the corneal surface, accelerating wound closure.
Additionally, the amniotic membrane has anti-scarring properties. It inhibits fibroblast activity, reducing the risk of corneal haze and scar formation that can interfere with vision. The tissue also contains anti-angiogenic factors, which prevent the growth of abnormal blood vessels into the cornea. Together, these properties help restore a healthier ocular surface environment.
Evidence Supporting Amniotic Membranes in Dry Eye
Clinical studies have demonstrated that amniotic membrane therapy can significantly improve both symptoms and ocular surface health in patients with severe dry eye. Patients treated with amniotic membranes often report decreased pain, reduced light sensitivity, and improved comfort. Objective findings such as increased tear film stability, reduced corneal staining, and improved epithelial integrity have also been documented.
The improvements are not only short-term. In some patients, amniotic membrane therapy provides long-lasting benefits by breaking the cycle of inflammation and epithelial breakdown. By restoring a healthier corneal surface, the treatment can make subsequent therapies, such as lubricants or prescription drops, more effective.
Advantages of Amniotic Membranes Over Standard Therapies
Conventional treatments for severe dry eye, including lubricating drops, autologous serum tears, or prescription anti-inflammatory medications, address symptoms and underlying inflammation but may not be sufficient when the corneal surface is severely damaged. Amniotic membranes provide a biologically active scaffold that promotes true tissue repair rather than temporary symptom relief.
Unlike artificial bandage contact lenses, which only protect the cornea mechanically, amniotic membranes deliver growth factors and healing proteins directly to the ocular surface. Compared with topical medications, they act more quickly and address multiple pathways of disease simultaneously, including inflammation, epithelial regeneration, and scarring.
Patient Selection and Considerations
Not every patient with dry eye requires amniotic membrane therapy. It is generally reserved for those with advanced disease where traditional therapies are not adequate. Candidates include patients with persistent epithelial defects, severe keratopathy due to dry eye, and those at risk of scarring or vision loss.
The procedure is safe, but patients should be aware of temporary visual blur while the membrane is in place. Most patients tolerate the treatment well, and complications are rare when it is applied appropriately. Follow-up care is important to monitor healing and assess the need for additional therapy.
Future Directions in Amniotic Membrane Therapy
Research continues to explore ways to optimize amniotic membrane therapy. Advances in preservation techniques aim to maintain higher concentrations of biologically active proteins for even greater effectiveness. Investigators are also studying combination approaches, where amniotic membranes are used alongside other therapies such as autologous serum tears or anti-inflammatory medications to maximize results.
In addition, the role of amniotic membranes in preventing disease progression is being studied. By restoring ocular surface health in severe dry eye, they may help reduce the risk of long-term complications such as corneal ulcers, perforations, and scarring.
While not all cases of dry eye disease are severe enough to warrant an amniotic membrane, many of the most severe cases would drastically benefit from the improved healing and restorative properties an amniotic membrane can provide. Your eye doctor can discuss whether or not your particular symptoms and signs of dry eye disease are enough to indicate the use of an amniotic membrane.
