Dr. Orwa Nasser MD MPH - Recurrent Corneal Erosion

Recurrent Corneal Erosion

Recurrent corneal erosion is a condition in which the corneal epithelium repeatedly breaks down or detaches from Bowman’s layer. In this condition, the epithelial cells do not adhere properly to the underlying tissue. Episodes may occur weeks, months, or years after an initial corneal injury. The condition can be painful but is treatable with appropriate management.

Symptoms:

    ·    Sudden sharp eye pain.

    ·    Foreign-body sensation.

    ·    Redness.

    ·    Excessive tearing.

    ·    Sensitivity to light.

    ·    Blurred vision during episodes.

    ·    Difficulty opening the eye due to discomfort.

    ·    Episodes commonly occur upon waking due to eyelid adhesion overnight.

Causes:

·    Previous corneal abrasion or injury.

·    Epithelial basement membrane dystrophy.

·    Poor healing of the corneal surface may weaken epithelial adhesion.

·    Dry eye disease may increase susceptibility.

·    Minor trauma may trigger repeated episodes.

Diagnosis and Tests:

·    Diagnosis begins with a detailed history of prior trauma or episodes.

·    Slit-lamp examination identifies loose or damaged epithelium.

·    Fluorescein staining highlights epithelial defects.

·    Evaluation for underlying corneal dystrophy is important.

·    The cornea may appear normal between episodes.

Management and Treatment:

·    Surgical treatment: In advanced cases and frequent recurrent episodes surgical treatment is advised which include

o   PTK (Phototherapeutic keratectomy) to smooth the corneal surface and may improve epithelial adhesion.

o   Anterior stromal puncture may be used to improve epithelial adhesion.

o   Superficial keratectomy may be considered in selected cases.

·    Treatment During an Acute Episode:

o   Lubricating drops should be used to protect the corneal surface.

o   Antibiotic drops or ointment to prevent infection.

o   Cycloplegic drops may be used to reduce discomfort in selected cases.

o   A bandage contact lens may be used to promote healing in certain cases.

o   Oral pain relievers may be used if needed.

·    Long-Term Preventive Treatment:

o   Frequent daytime lubrication to support epithelial stability.

o   Nighttime ointment to reduce eyelid adhesion.

o   Hypertonic saline ointment may be used to decrease epithelial swelling.

o   Management of dry eye disease is essential in these cases.

Prognosis:

·    The prognosis is generally favorable with consistent treatment.

·    Many patients experience fewer recurrences over time.

·    Untreated cases may increase infection or scarring risk.

·    Long-term lubrication significantly improves outcomes.

Prevention:

·    Regular use of lubricating drops reduces recurrence risk.

·    Nighttime ointment helps prevent eyelid adhesion.

·    Avoiding eye rubbing is recommended.

·    Prompt treatment of corneal abrasions is important.

·    Managing dry eye disease lowers recurrence risk.

When Should I See My Healthcare Provider? Seek evaluation if repeated episodes of sudden eye pain occur or vision remains blurred after healing.

When Should I Go to the Emergency Room? Seek emergency care if severe worsening pain, significant vision loss, or signs of infection develop.

What Questions Should I Ask My Healthcare Provider?

    ·    Do I have underlying corneal dystrophy?

    ·    How can I prevent future episodes?

    ·    Should I use nighttime ointment long term?

    ·    Am I a candidate for procedural treatment?

    ·    How often should I follow up?

Key Takeaways:

    ·    Recurrent corneal erosion involves repeated epithelial breakdown.

    ·    Episodes often occur upon waking.

    ·    Previous trauma is a common cause.

    ·    Treatment includes lubrication and sometimes procedures.

    ·    Prevention reduces recurrence frequency.