The epithelium is separated from the stroma by a membrane. In map-dot-fingerprint dystrophy, this membrane develops abnormally exhibiting a map-like appearance or perhaps opaque dots. Sometimes lines are formed that resemble small fingerprints. In some cases, this irregular structure can lead to painful epithelial erosions.
In Boehm Syndrome, recurrent epithelial erosions occur only when the eyelids are opened after some period of sleep. Recurrent corneal erosions may happen at any time of night or day. Boehm Syndrome does not. It occurs only when the inside of the eyelid tears away epithelial cells after minutes or hours of sleep. This may expose nerve endings, causing moderate to severe pain for hours or days. Once the erosions begin, even periods of brief sleep can exacerbate the problem.
Patients may describe the sensation as "my eyelids stick to my eyes when I try to open them, which is immediately followed by intense pain". In some cases, this syndrome may disappear after one or more episodes. For others, it may be a lifelong disease.
Treatment may include some of the standard procedures used on corneal erosions, like corneal abrasion.
There has been some success with the use of highly permeable extended-wear contact lenses worn only during sleep. These lenses, often referred to as "bandage lenses", or "contact bandages" are prescribed with the lowest available prescription, as they simply act as a buffer between the surface of the cornea and the eyelids.
Optionally, the patient may cover their eyes with food grade plastic wrap worn like a mask. The plastic should be folded to resemble pleated drapes and tucked behind the ears, then covered by a regular sleeping mask. This method has proven successful even in chronic cases.